Acute coronary syndrome as a cause of sudden death in patients with old myocardial infarction: a pathological analysis

• Published in: Legal medicine (Tokyo, Japan) Vol. 5; pp. S292 - S294
• Main Authors: Takada, Aya, Saito, Kazuyuki, Ro, Ayako, Kobayashi, Masahiko, Hamamatsu, Akihiko, Murai, Tatsuya, Kuroda, Naohito
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier Ireland Ltd 01.03.2003
• Subjects: Acute coronary syndrome; Acute Disease; Acute myocardial infarction; Aged; Aged, 80 and over; Arrhythmias, Cardiac - complications; Arrhythmias, Cardiac - pathology; Coronary Artery Disease - complications; Coronary Artery Disease - pathology; Coronary Disease - complications; Coronary Disease - pathology; Coronary Thrombosis - complications; Coronary Thrombosis - pathology; Death, Sudden, Cardiac - etiology; Death, Sudden, Cardiac - pathology; Female; Forensic pathology; Heart Failure - complications; Heart Failure - pathology; Heart Rupture; Humans; Male; Middle Aged; Myocardial Infarction - complications; Myocardial Infarction - pathology; Old myocardial infarction; Sudden death; Ventricular arrhythmia; Ventricular arrhythmia; Old myocardial infarction; Forensic pathology; Acute coronary syndrome; Acute myocardial infarction; Sudden death
• ISSN: 1344-6223; 1873-4162
• DOI: 10.1016/S1344-6223(02)00153-0

Old myocardial infarction (OMI) is one of the most important pathological manifestations in sudden cardiac death. Fatal arrhythmia arising from a fibrotic scar has been determined as the cause of death in most cases with old myocardial infarction. However, the significance of acute plaque disruption/thrombosis of the coronary arteries in those patients has not been investigated. We examined a series of 33 hearts from individuals with OMI who died suddenly during the period from 1998 to 2001. Detailed coronary pathological findings on these hearts indicated fresh or recent rupture of the coronary plaque with thrombosis in 18 cases (55%). As a result of comprehensive analysis, the sudden deaths were explained by acute coronary syndrome in 18 cases (55%), fatal arrhythmia in eight (24%), cardiac pump failure in five (14%), and other causes in two (6%) cases. Our findings revealed that a new coronary plaque rupture independent of the old infarct was a major cause of sudden cardiac death with OMI.