Qiao J H, Fishbein M C
Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, California 90048.
J Am Coll Cardiol. 1991 Apr;17(5):1138-42. doi: 10.1016/0735-1097(91)90844-y.
Atherosclerotic plaque rupture with superimposed thrombosis is recognized as the lesion causing greater than 90% of acute myocardial infarctions. To determine the severity of atherosclerosis at the site of plaque rupture, 184 coronary arteries from autopsies of 162 patients who died of acute myocardial infarction were studied. There were 102 men, 72 +/- 10 years old (mean +/- SD), and 60 women, 75 +/- 8 years old. All arteries were dissected from the heart, fixed, decalcified, cut at 2 to 3 mm intervals and processed routinely for histologic examination. A planimeter was used to measure artery, plaque, thrombus and luminal cross-sectional area at the site of plaque rupture with thrombosis in sections projected at x13.8 magnification. At the site of atherosclerotic plaque rupture with superimposed thrombosis, the degree of stenosis due to plaque was: 90 +/- 7% for the right (n = 67), 91 +/- 6% for the left anterior descending (n = 79) and 91 +/- 6% for the left circumflex (n = 38) coronary arteries. Plaque rupture in fatal acute myocardial infarction occurs at sites of severe narrowing (mean 91%, range 67% to 99%). Thus, plaque rupture with thrombosis is unlikely to cause the fatal acute myocardial infarction in patients with mild to moderate coronary stenosis.
动脉粥样硬化斑块破裂伴血栓形成被认为是导致超过90%急性心肌梗死的病变。为了确定斑块破裂部位动脉粥样硬化的严重程度，对162例死于急性心肌梗死患者尸检的184条冠状动脉进行了研究。其中男性102例，年龄72±10岁（均值±标准差），女性60例，年龄75±8岁。所有动脉均从心脏取出，固定、脱钙，每隔2至3毫米切片，并常规进行组织学检查。使用面积计在放大13.8倍投影的切片中测量斑块破裂伴血栓形成部位的动脉、斑块、血栓和管腔横截面积。在动脉粥样硬化斑块破裂伴血栓形成的部位，斑块导致的狭窄程度为：右冠状动脉（n = 67）90±7%，左前降支（n = 79）91±6%，左旋支（n = 38）91±6%。致命性急性心肌梗死中的斑块破裂发生在严重狭窄部位（平均91%，范围67%至99%）。因此，斑块破裂伴血栓形成不太可能在轻度至中度冠状动脉狭窄的患者中导致致命性急性心肌梗死。
