Heart 1999;82:269-272 ( September )

Plaque erosion is a major substrate for coronary thrombosis in acute myocardial infarction

E Arbustini^a, B Dal Bello^a, P Morbini^a, A P Burke^c, M Bocciarelli^a, G Specchia^b, R Virmani^c

^a Department of Pathology, IRCCS-Policlinico San Matteo, Via Forlanini 16, 27100 Pavia, Italy, ^b Department of Cardiology, IRCCS-Policlinico San Matteo, ^c Department of Cardiovascular Pathology, Armed Forces Institute of Pathology, Washington, DC, USA

Correspondence to: Dr Arbustini. email: e.arbustini{at}smatteo.pv.it

Accepted for publication 10 June 1999

OBJECTIVETo evaluate the prevalence of plaque erosion as a substrate for coronary thrombosis.
DESIGNPathological study in patients with acute myocardial infarction not treated with thrombolysis or coronary interventional procedures.
PATIENTS298 consecutive patients (189 men, mean (SD) age 66 (11) years; 109 women, 74 (8) years) dying in hospital between 1984 and 1996 from acute myocardial infarction, diagnosed by ECG changes and rise in cardiac enzymes.
MAIN OUTCOME MEASURESHistopathological determination of plaque erosion as substrate for acute thrombosis; location and histological type of coronary thrombosis; acute and healed myocardial infarcts; ventricular rupture.
RESULTSAcute coronary thrombi were found in 291 hearts (98%); in 74 cases (25%; 40/107 women (37.4%) and 34/184 men (18.5%); p = 0.0004), the plaque substrate for thrombosis was erosion. Healed infarcts were found in 37.5% of men v 22% of women (p = 0.01). Heart rupture was more common in women than in men (22% v 10.5%, p = 0.01). The distribution of infarcts, thrombus location, heart rupture, and healed infarcts was similar in cases of plaque rupture and plaque erosion.
CONCLUSIONSPlaque erosion is an important substrate for coronary thrombosis in patients dying of acute myocardial infarction. Its prevalence is significantly higher in women than in men.


Keywords: plaque erosion; rupture; acute myocardial infarction

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© 1999 by Heart
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