Dressler F A, Roberts W C
Pathology Branch, National Institutes of Health, Bethesda, Maryland.
Am J Cardiol. 1989 Oct 15;64(14):909-20. doi: 10.1016/0002-9149(89)90841-2.
One hundred sixty-eight opiate addicts, whose hearts were submitted for necropsy study, were examined with prime focus on modes of death and types of cardiac abnormalities. Twenty various modes of death were identified: active infective endocarditis or its consequences in 67 (40%), drug overdose in 39 (24%), coronary artery disease in 14 (8%), pulmonary granulomatosis in 7 (4%) and 15 various diseases (7 cardiac and 8 noncardiac) in the remaining 41 (24%) patients. Of the 168 hearts examined, only 7 (4%) were normal. Although infective endocarditis (active, healed or both) was most common (80 [48%] patients), there was a broad range of other cardiac abnormalities present: cardiomegaly in 114 (68%) (including 22 patients without another cardiac abnormality), coronary artery disease in 35 (21%), acquired valvular heart disease in 16 (10%), myocardial heart disease in 14 (8%) and a congenital cardiac anomaly in 19 (11%). Of the 35 hearts with various coronary artery diseases, 28 had significant (greater than 75%) narrowing of the cross-sectional area of 1 or more of the 4 major (left main, left anterior descending, left circumflex and right) epicardial coronary arteries by atherosclerotic plaque. Of 112 coronary arteries in these 28 hearts, 52 (46%) were significantly narrowed (a mean of 1.9 of the 4 major coronary arteries/patient). In 27 of these 28 cases, each 5-mm segment of the 4 major coronary arteries was examined histologically. Of the 1,435 five-mm segments examined, 189 (13%) were narrowed 76 to 100% in cross-sectional area by plaque; 347 (24%), 51 to 75%; 336 (23%), 26 to 50%; and 563 segments (39%) were narrowed 0 to 25% in cross-sectional area by plaque. The percents of 5-mm segments narrowed 76 to 100% in cross-sectional area were greater in those patients with (128 of 793 [16%]) than without (61 of 642 [9%]) clinical evidence of myocardial ischemia (p = 0.001). In this study a very high frequency of cardiac abnormalities (161 [96%]) was found at necropsy and most deaths (97 [58%]) were related to cardiac disease. Although death was most often due to diseases whose association to opiate addiction is well recognized (such as infective endocarditis, drug overdose and pulmonary granulomatosis from the venous injection of talc), several other modes of death were present. Most prominent among these was coronary artery disease (14 patients [8%]).
168名接受尸检研究的阿片类药物成瘾者，重点检查了死亡方式和心脏异常类型。确定了20种不同的死亡方式：活动性感染性心内膜炎及其后果67例（40%），药物过量39例（24%），冠状动脉疾病14例（8%），肺部肉芽肿7例（4%），其余41例（24%）患者患有15种不同疾病（7种心脏疾病和8种非心脏疾病）。在检查的168颗心脏中，只有7颗（4%）正常。虽然感染性心内膜炎（活动性、愈合性或两者皆有）最为常见（80例[48%]患者），但还存在广泛的其他心脏异常：心脏肥大114例（68%）（包括22例无其他心脏异常的患者），冠状动脉疾病35例（21%），后天性瓣膜性心脏病16例（10%），心肌病14例（8%），先天性心脏异常19例（11%）。在35例患有各种冠状动脉疾病的心脏中，28例有1条或更多4条主要（左主干、左前降支、左旋支和右）心外膜冠状动脉的横截面积因动脉粥样硬化斑块而显著（大于75%）狭窄。在这28颗心脏的112条冠状动脉中，52条（46%）显著狭窄（平均每位患者4条主要冠状动脉中有1.9条）。在这28例中的27例中，对4条主要冠状动脉的每5毫米节段进行了组织学检查。在检查的1435个5毫米节段中，189个（13%）因斑块导致横截面积狭窄76%至100%；347个（24%），51%至75%；336个（23%），26%至50%；563个节段（39%）因斑块导致横截面积狭窄0%至25%。横截面积狭窄76%至100%的5毫米节段百分比在有心肌缺血临床证据的患者（793例中的128例[16%]）中高于无此证据的患者（642例中的61例[9%]）（p = 0.001）。在本研究中，尸检发现心脏异常的频率非常高（161例[96%]），大多数死亡（97例[58%]）与心脏病有关。虽然死亡最常归因于与阿片类药物成瘾关联已得到充分认识的疾病（如感染性心内膜炎、药物过量和静脉注射滑石粉导致的肺部肉芽肿），但还存在其他几种死亡方式。其中最突出的是冠状动脉疾病（14例患者[8%]）。
