University Center of Legal Medicine Lausanne-Geneva, Chemin de la Vulliette 4, CH - 1000, Lausanne 25, Switzerland.
Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland.
Int J Legal Med. 2021 Sep;135(5):1829-1836. doi: 10.1007/s00414-021-02586-z. Epub 2021 Apr 13.
Sudden cardiac death (SCD) related to atherosclerotic coronary artery disease (ACAD) resulting in myocardial infarction is the most prevalent cause of death in western countries. In clinical practice, coronary artery calcium score (CACS) is considered an independent predictor of coronary events, closely related to atherosclerotic burden and is quantified radiologically by the Agatston score being calculated through computed tomography. Postmortem computed tomography (PMCT) allows the visualization and quantification of coronary calcifications before the autopsy. However, it was reported that some patients who died from severe ACAD had a zero CACS in PMCT. In this study, a retrospective evaluation of CACS in adult's myocardial infarction cases related to ACAD, with available CACS and histological slides of coronary arteries, was performed in order to gain a deeper understanding of coronary calcifications and their role in myocardial infarction cases. The CACS was calculated by using the software Smartscore 4.0 after the radiological examination on a 64-row CT unit using a specific cardiac protocol. Thirty-six cases were identified out of 582 autopsies, recorded during a 2-year study period (29 men, 7 women; age 56.3 ± 11.7). CACS was 0-10 in 5 cases (5 men, 44.8 ± 13.7), 11-100 in 8 cases (6 men, 2 women, 53.1 ± 7.7), 101-400 in 13 cases (11 men, 2 women, 57.4 ± 9.6), and > 400 in 10 cases (9 men, 1 woman, 63.1 ± 11.9). Coronary thrombosis was found in 28 cases, histologically identified as plaque erosions in 6 cases and as plaque ruptures in 22 cases. Statistical analyses showed that CACS increases significantly with age (p-value < 0.05) and does not show significant correlation with gender, body weight, body mass index, and heart weight. CACS was significantly higher in plaque ruptures than in plaque erosions (p-value < 0.01). Zero or low CACS on unenhanced PMCT cannot exclude the presence of myocardial infarction related to ACAD. This paradoxical discrepancy between imaging and autopsy findings can be explained considering the histological aspect of fatal coronary plaques.
因动脉粥样硬化性冠状动脉疾病（ACAD）导致心肌梗死的心脏性猝死（SCD）是西方国家最常见的死亡原因。在临床实践中，冠状动脉钙评分（CACS）被认为是冠状动脉事件的独立预测因子，与动脉粥样硬化负担密切相关，并通过计算体层摄影术的 Agatston 评分进行放射学量化。死后计算机断层扫描（PMCT）可在尸检前可视化和量化冠状动脉钙化。然而，据报道，一些死于严重 ACAD 的患者在 PMCT 中 CACS 为零。在这项研究中，对与 ACAD 相关的成人心肌梗死病例的 CACS 进行了回顾性评估，这些病例有 CACS 和冠状动脉组织学切片可供评估，以便更深入地了解冠状动脉钙化及其在心肌梗死病例中的作用。使用特定的心脏协议，在 64 排 CT 机上进行放射学检查后，使用 Smartscore 4.0 软件计算 CACS。在为期 2 年的研究期间，从 582 例尸检中确定了 36 例病例（29 名男性，7 名女性；年龄 56.3±11.7）。5 例（5 名男性，44.8±13.7）CACS 为 0-10，8 例（6 名男性，2 名女性，53.1±7.7）CACS 为 11-100，13 例（11 名男性，2 名女性，57.4±9.6）CACS 为 101-400，10 例（9 名男性，1 名女性，63.1±11.9）CACS>400。28 例发现冠状动脉血栓形成，组织学上发现 6 例为斑块侵蚀，22 例为斑块破裂。统计分析显示，CACS 随年龄显著增加（p 值<0.05），与性别、体重、体重指数和心脏重量无显著相关性。斑块破裂的 CACS 明显高于斑块侵蚀（p 值<0.01）。未增强 PMCT 的零或低 CACS 不能排除与 ACAD 相关的心肌梗死的存在。这种影像学和尸检结果之间的矛盾差异可以从致命性冠状动脉斑块的组织学方面来解释。
