Corrado D, Basso C, Poletti A, Angelini A, Valente M, Thiene G
Department of Pathology, University of Padua Medical School, Italy.
Circulation. 1994 Nov;90(5):2315-23. doi: 10.1161/01.cir.90.5.2315.
Atherosclerotic coronary artery disease, complicated by acute thrombosis, is the usual cause of sudden death in adults. This study addresses the pathology of coronary arteries in sudden death in the young (< or = 35 years old).
Among 200 consecutive cases of sudden death in youth in the Veneto region of Italy, 37 (33 men and 4 women, age 18 to 35 years; mean, 29.4 years) showed obstructive atherosclerotic coronary artery disease in the absence of other cardiac pathological conditions and causes of death. No patient had previous angina pectoris or myocardial infarction. Cardiac arrest occurred at rest in 30 subjects and was related to effort in 7. A histological study was carried out on the obstructive coronary plaques. Degree of lumen stenosis and extension of lipid core and intimal fibrocellular hyperplasia facing the lumen were calculated morphometrically. Immunohistochemistry and electron microscopy were used to further characterize the plaque cell population. Single-vessel disease was found in 33 patients and triple-vessel disease in 4, with an overall total of 45 obstructive plaques, 34 of which were located in the proximal left anterior descending coronary artery. At histological study, only 10 plaques from 10 patients showed acute thrombosis (occlusive in 5 and subocclusive in 5); the remaining 35 were uncomplicated. Thirty-one plaques were fibrous in nature, while the other 14 were atheromatous. Compared with the atheromatous lesions, the fibrous plaques were rarely complicated by thrombosis (3% versus 64%; P < .001) and distinctly exhibited a fairly well-preserved tunica media (81% versus 21%; P < .001) as well as a stratum of neointimal fibrocellular hyperplasia (68% versus 7%; P < .001), which on immunohistochemistry and electron microscopy appeared to be proliferating smooth muscle cells.
In our study population, sudden death was precipitated by acute coronary thrombosis in only 27% of patients with obstructive coronary atherosclerotic plaque. Most of the young victims of sudden death with obstructive coronary atherosclerosis showed single-vessel disease that affected the left anterior descending coronary artery and was due to fibrous plaques with neointimal smooth muscle cell hyperplasia and a preserved tunica media in the absence of acute thrombosis.
动脉粥样硬化性冠状动脉疾病合并急性血栓形成是成年人猝死的常见原因。本研究探讨青年（≤35岁）猝死患者冠状动脉的病理学情况。
在意大利威尼托地区连续200例青年猝死病例中，37例（33例男性和4例女性，年龄18至35岁；平均29.4岁）在无其他心脏病理状况及死因的情况下存在阻塞性动脉粥样硬化性冠状动脉疾病。无患者既往有胸痛或心肌梗死病史。30例患者静息时发生心脏骤停，7例与运动有关。对阻塞性冠状动脉斑块进行了组织学研究。通过形态计量学计算管腔狭窄程度、脂质核心延伸情况以及面向管腔的内膜纤维细胞增生情况。采用免疫组织化学和电子显微镜进一步对斑块细胞群体进行特征分析。33例患者为单支血管病变，4例为三支血管病变，共有45个阻塞性斑块，其中34个位于左前降支冠状动脉近端。组织学研究显示，仅10例患者的10个斑块出现急性血栓形成（5个为闭塞性，5个为非闭塞性）；其余35个斑块无并发症。31个斑块本质上为纤维性，另外14个为动脉粥样硬化性。与动脉粥样硬化性病变相比，纤维性斑块很少并发血栓形成（3%对64%；P<.001），且明显表现出中膜保存较好（81%对21%；P<.001）以及新内膜纤维细胞增生层（68%对7%；P<.001），免疫组织化学和电子显微镜显示该增生层为增殖的平滑肌细胞。
在我们的研究人群中，仅有27%的阻塞性冠状动脉粥样硬化斑块患者因急性冠状动脉血栓形成而猝死。大多数患有阻塞性冠状动脉粥样硬化的青年猝死受害者表现为单支血管病变，累及左前降支冠状动脉，病因是纤维性斑块伴新内膜平滑肌细胞增生且中膜保存完好，无急性血栓形成。
