A detailed pathological study of the coronary arteries was carried out on 130 random white subjects (91 male and 39 female) who died suddenly in the Glasgow area. In 30 there was a clearly defined cause of death that was not due to ischaemic heart disease. In eight subjects the cause of death was in doubt. Ninety two of the 130 showed coronary stenosis resulting in a loss of more than 75% of coronary artery cross sectional area and/or acute coronary events with no other cause of death. Of these 92 subjects considered to have died suddenly of ischaemic heart disease, 64% showed plaque rupture and thrombosis which occurred at sites of previous high grades of stenosis. Twenty two subjects had intraluminal thrombosis unrelated to plaque fissuring. Thirty eight (41%) showed histological evidence of recent myocardial necrosis; acute coronary events occurred in 34 of these. There was no correlation between the duration of symptoms before death and the occurrence of acute coronary events. Acute coronary events, mainly in the form of plaque rupture, are a common finding in sudden coronary death when a careful study is made of the whole coronary arterial tree.
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