Advertisement

Morphological Findings in the Coronary Arteries in Fatal Coronary Artery Disease

  • W. C. Roberts
Chapter
  • 38 Downloads
Part of the Argenteuil Symposia book series (ARGENTEUIL)

Abstract

Atherosclerotic coronary artery disease (CAD) is the most common cause of death in the Western world. One American dies every minute because of atherosclerotic CAD. In the USA alone, about 6 million persons have symptomatic myocardial ischemia because of atherosclerotic CAD. About 250000 coronary artery bypass grafting operations were performed in 1990 in the USA and about 300000 coronary angioplasty procedures. The cause of atherosclerosis is now clear. The evidence is overwhelming that atherosclerosis is a cholesterol problem. The higher the blood total cholesterol level (specifically the low-density lipoprotein level) the greater the chance of developing symptomatic CAD, the greater the chance of having fatal CAD, and the greater the extent of the atherosclerotic plaques. Furthermore, lowering the blood total cholesterol level decreases the chances of having symptomatic or fatal CAD and the greater the chance that some atherosclerotic plaques will actually become smaller, i.e. regress. Although the coronary arteries have been examined by visual inspection at necropsy for over 100 years, only in recent years has the extent of the atherosclerotic process in the coronary arteries in patients with symptomatic or fatal CAD become appreciated. This chapter initially reviews the status of the major epicardial coronary arteries in various subsets of patients with fatal atherosclerotic CAD. It then describes the effects of angioplasty on these arteries, some observations in patients having thrombolytic therapy and coronary bypass, and then various complications of myocardial ischemia.

Keywords

Atherosclerotic Plaque Major Coronary Artery Native Coronary Artery Occlusive Thrombus Coronary Thrombus 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Arnett EN, Isner JM, Redwood DR, Kent KM, Baker WP, Ackerstein M, Roberts WC (1979) Coronary artery narrowing in coronary heart disease: comparison of cineangiographic and necropsy findings. Ann Intern Med 91:350–356PubMedGoogle Scholar
  2. Brosius FC III, Roberts WC (1981) Significance of coronary arterial thrombus in transmural acute myocardial infarction: a study of 54 necropsy patients. Circulation 63:810PubMedCrossRefGoogle Scholar
  3. Bulkley BM, Roberts WC (1976) Atherosclerotic narrowing of the left main coronary artery: a necropsy analysis of 152 patients with fatal coronary heart disease and varying degrees of left main narrowing. Circulation 53:823–828PubMedGoogle Scholar
  4. Cabin HS, Roberts WC (1980) True left ventricular aneurysm and healed myocardial infarction. Clinical and necropsy observations including quantification of degree of coronary arterial narrowing. AM J Cardiol 46:754PubMedCrossRefGoogle Scholar
  5. Gertz SD, Kalan JM, Kragel AH, Roberts WC, Braunwald E, The TIMI Investigators (1990a) Cardiac morphologic findings in patients with acute myocardial infarction treated with recombinant tissue plasminogen activator. Am J Cardiol 65:953–961PubMedCrossRefGoogle Scholar
  6. Gertz SD, Kragel AH, Kalan JM, Braunwald E, Roberts WC, The TIMI Investigators (1990b) Comparison of coronary and myocardial morphologic findings in patients with and without thrombolytic therapy during fatal first acute myocardial infarction. Am J Cardiol 66:904–909PubMedCrossRefGoogle Scholar
  7. Herrick JB (1919) Thrombosis of the coronary arteries. JAMA 72:387Google Scholar
  8. Isner JM, Kishel J, Kent KM, Ronan JA Jr, Ross AM, Roberts WC (1981) Accuracy of angiographic determination of left main coronary arterial narrowing. Angiographic-histologic correlative analysis in 28 patients. Circulation 63:1056–1064PubMedCrossRefGoogle Scholar
  9. Kalan JM, Roberts WC (1990) Morphologic findings in saphenous veins used as coronary arterial bypass conduits for longer than 1 year: necropsy analysis of 53 patients, 123 saphenous veins, and 1865 5-mm segments of veins. Am Heart J 119:1164–1184PubMedCrossRefGoogle Scholar
  10. Kragel AH, Reddy SG, Wittes JT, Roberts WC (1989) Morphometric analysis of the composition of atherosclerotic plaques in the four major epicardial coronary arteries in acute myocardial infarction and in sudden coronary death. Circulation 80:1747–1756PubMedCrossRefGoogle Scholar
  11. Kragel AH, Reddy SG, Wittes JT, Roberts WC (1990) Morphometric analysis of the composition of coronary arterial plaques in isolated unstable angina pectoris with pain at rest. Am J Cardiol 66:562–567PubMedCrossRefGoogle Scholar
  12. Kragel AH, Gertz SD, Roberts WC (1991) Morphologic comparison of frequency and types of acute lesions in the major epicardial coronary arteries in unstable angina pectoris, sudden coronary death, and acute myocardial infarction. J Am Coll Cardiol 1818CrossRefGoogle Scholar
  13. Potkin BN, Roberts WC (1988) Location of an acute myocardial infarct in patients with a healed myocardial infarct: analysis of 129 patients studied at necropsy. Am J Cardiol 62:1017–1023PubMedCrossRefGoogle Scholar
  14. Roberts WC (1978) Coronary embolism. A review of causes, consequences, and diagnostic considerations. Cardiovasc Med 3:699Google Scholar
  15. Roberts WC (1989) Qualitative and quantitative comparison of amounts of narrowing by atherosclerotic plaques in the major epicardial coronary arteries at necropsy in sudden coronary death, transmural acute myocardial infarction, transmural healed myocardial infarction and unstable angina pectoris. Am J Cardiol 64:324–328PubMedCrossRefGoogle Scholar
  16. Roberts WC (1990) Lipid-lowering therapy after an atherosclerotic event. Am J Cardiol 65:16F–18FPubMedCrossRefGoogle Scholar
  17. Roberts WC, Buja LM (1972) The frequency and significance of coronary arterial thrombi and other observations in fatal acute myocardial infarction: a study of 107 necropsy patients. Am J Med 52:425PubMedCrossRefGoogle Scholar
  18. Roberts WC, Jones AA (1979) Quantitation of coronary arterial narrowing at necropsy in sudden coronary death: analysis of 31 patients and comparison with 25 control subjects. Am J Cardiol 44:39PubMedCrossRefGoogle Scholar
  19. Roberts WC, Jones AA (1980) Quantification of coronary arterial narrowing at necropsy in acute transmural myocardial infarction: analysis and comparison of findings in 27 patients and 22 controls. Circulation 61:786PubMedGoogle Scholar
  20. Roberts WC, Virmani R (1979) Quantification of coronary arterial narrowing in clinically isolated unstable angina pectoris: an analysis of 22 necropsy patients. Am J Med 67:792PubMedCrossRefGoogle Scholar
  21. Virmani R, Roberts WC (1980) Quantification of coronary arterial narrowing and of left ventricular myocardial scarring in healed myocardial infarction with chronic eventually fatal congestive cardiac failure. Am J Med 68:831PubMedCrossRefGoogle Scholar
  22. Virmani R, Roberts WC (1981) Non-fatal healed transmural myocardial infarction and fatal non-cardiac disease: qualification and quantification of coronary arterial narrowing and of left ventricular scarring in 18 necropsy patients. Br Heart J 45:434PubMedCrossRefGoogle Scholar
  23. Waller BF, Roberts WC (1980) Amount of narrowing by atherosclerotic plaque in 44 nonbypassed and 52 bypassed major epicardial coronary arteries in 32 necropsy patients who died within 1 month of aortocoronary bypass grafting. Am J Cardiol 46:956PubMedCrossRefGoogle Scholar
  24. Wartman WB, Hellerstein HK (1948) The incidence of heart disease in 2000 consecutive autopsies. Ann Intern Med 28:41PubMedGoogle Scholar

Copyright information

© Springer-Verlag London Limited 1992

Authors and Affiliations

  • W. C. Roberts

There are no affiliations available

Personalised recommendations