Coronary Artery Sclerosis and Major Causes of Death in the Aged

• Published in: Nihon Rōnen Igakkai zasshi Vol. 25; no. 6; pp. 581 - 585
• Main Authors: Matsushita, Satoru, Okai, Yoko, Kuramoto, Kizuku, Kuro-o, Makoto
• Format: Journal Article
• Language: Japanese
• Published: Japan The Japan Geriatrics Society 1988
• Subjects: Age Factors; Aged; Aged, 80 and over; Cause of Death; causes of death; Coronary Artery Disease - complications; Coronary Artery Disease - mortality; coronary sclerosis; Humans; malignant neoplasm; myocardial infarction; Myocardial Infarction - complications; Myocardial Infarction - mortality; Neoplasms - complications; Neoplasms - mortality; pneumonia; Pneumonia - complications; Pneumonia - mortality
• ISSN: 0300-9173
• DOI: 10.3143/geriatrics.25.581

To clarify a relationship between coronary artery sclerosis and major causes of death in the aged, we analyzed the 3657 serial autopsy cases in the past 14 years at Tokyo Metropolitan Geriatric Hospital. The average age at autopsy was 77.7 years old. The subjects were divided into four groups according to the number of major coronary arterial branches with more than 75% stenosis, i.e., from 0-vessel disease (0-VD) to 3-vessel disease (3-VD), and the major causes of death were compared among these four groups. Death by acute myocardial infarction (AMI) and ruptured abdominal aortic aneurysm increased with advance of coronary sclerosis, whereas death by malignant neoplasm decreased (34.4% in 0-VD, 30.3% in 1-VD, 27.8% in 2-VD, and 18.9% in 3-VD). Death by pneumonia increased with aging (11.4% in sixties, 17.7% in seventies, 23.9% in eighties, 25.3% in nineties), and was considered to be an important morbility factor in the aged. Death rates due to AMI were 0.9% in 0-VD, 4.5% in 1-VD, 12.2% in 2-VD, and 29.5% in 3-VD. In 3-VD, it was especially high when left main truncus (LMT) was affected (40.7%). In 2-VD, it was higher when the left anterior descending artery (LAD) was affected (13.1%) compared with cases without LAD lesion (8.5%). On the contrary, death by congestive heart failure (CHF) occurred most frequently in 2-VD without LAD stenosis (7.3%). These facts suggest that occlusion of LMT or LAD tends to produce massive myocardial damage, causing death from AMI in the acute phase but that considerable numbers of patients with occlusion of the right coronary artery or left circumflex can survive the acute phase of AMI but subsequently succumb to CHF in the chronic phase.