Plaque histology and CAD

[gmohan]

Plaque histology and myocardial disease in sudden coronary death: the Fingesture study

European Heart Journal, ehac533,

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Abstract
Aims
At least 50% of deaths due to coronary artery disease (CAD) are sudden cardiac deaths (SCDs), but the role of acute plaque complications on the incidence of sudden death in CAD is somewhat unclear. The present study aimed to investigate plaque histology and concomitant myocardial disease in sudden coronary death.

Methods and results
The study population is derived from the Fingesture study, which has collected data from 5869 consecutive autopsy-verified SCD victims in Northern Finland (population ≈600 000) between 1998 and 2017. In this substudy, histological examination of culprit lesions was performed in 600 SCD victims whose death was due to CAD. Determination of the cause of death was based on the combination of medical records, police reports, and autopsy data. Plaque histology was classified as either (i) plaque rupture or erosion, (ii) intraplaque haemorrhage, or (iii) stable plaque. The mean age of the study subjects was 64.9 ± 11.2 years, and 82% were male. Twenty-four per cent had plaque rupture or plaque erosion, 24% had an intraplaque haemorrhage, and 52% had a stable plaque. Myocardial hypertrophy was present in 78% and myocardial fibrosis in 93% of victims. The presence of myocardial hypertrophy or fibrosis was not associated with specific plaque histology.

Conclusion
Less than half of sudden deaths due to CAD had evidence of acute plaque complication, an observation which is contrary to historical perceptions. The prevalence of concomitant myocardial disease was high and independent of associated plaque morphology.

G Mohan

[Badri]

Mohan,

This is yet another study which confirms that about 50% of all Sudden Cardiac Deaths is due to coronary artery disese. So, can you explain to us what exactly happens to the heart when coronary artery is involved. What exactly do they mean when they say "In Less than half of sudden deaths due to "CAD" plaque is involved". So what is the cause of death in the other 50% of SCDs.