Atheromas that cause fatal thrombosis are usually large and frequently accompanied by vessel enlargement

被引:16
作者
Bezerra, HG
Higuchi, MD
Gutierrez, PS
Palomino, SA
Silvestre, JML
Libby, P
Ramires, JAF
机构
[1] Univ Sao Paulo, Sch Med, Heart Inst InCor, BR-05403000 Sao Paulo, Brazil
[2] Harvard Univ, Brigham & Womens Hosp, Sch Med, Boston, MA 02115 USA
基金
巴西圣保罗研究基金会;
关键词
atherosclerosis; remodeling; plaque; myocardial infarction; pathology;
D O I
10.1016/S1054-8807(01)00070-9
中图分类号
R5 [内科学];
学科分类号
1002 [临床医学]; 100201 [内科学];
摘要
Several lines of clinical evidence show that AMI frequently occurs at sites with mild to moderate degree of coronary stenosis. The degree of luminal stenosis depends on plaque deposition and degree of vessel remodeling, features poorly assessed by coronary angiography. This postmortem study tested the hypothesis that the size of coronary atheroma and the type of remodeling distinguish culprit lesion responsible for fatal AMI from equi-stenotic nonculprit lesion in the same coronary tree. The main coronary branches from 36 consecutive patients with fatal AMI were studied. The culprit lesion (Group 1) and an equi-stenotic nonculprit segment (Group 2) obtained in measurements of another coronary branch from the same patient were compared. Morphometry and plaque composition was assessed in both groups. Compared to Group 2, Group 1 had larger areas of plaque 9.6 vs. 4.7 mm(2), vessel 12.7 vs. 7.4 mm(2) and lumen 1.7 vs. 1.2 mm(2); (P < .01). Positive remodeling was more frequent in Group I than Group 2: 21/30 (70%) vs. 8/26 (31%). Plaque area correlated positively with lipid core and macrophages and negatively with fibrosis and smooth muscle cells. Atherosclerotic plaques that cause fatal thrombosis are more frequently positively remodeled and tend to be larger than nonculprit plaques with the same degree of cross-sectional stenosis. We tested whether arterial remodeling and plaque size vary between segments containing a fatal thrombosed plaque versus an equi-stenotic nonculprit plaque. Culprit vessel segments had higher cross-sectional areas of intimal plaque and of vessel wall than equi-stenotic nonculprit plaques. The cross-sectional area of the vessel correlated positively with both the lipid core area and CD68(+) macrophage content, and negatively with fibrosis area and smooth muscle cell content. These results add elements explaining limitations of angiography in identifying plaques and provide new insights into the role of remodeling in plaque instability. (C) 2001 Elsevier Science Inc. All rights reserved.
引用
收藏
页码:189 / 196
页数:8
相关论文
共 38 条
[1]
ANGIOGRAPHIC EVOLUTION OF CORONARY-ARTERY MORPHOLOGY IN UNSTABLE ANGINA [J].
AMBROSE, JA ;
WINTERS, SL ;
ARORA, RR ;
ENG, A ;
RICCIO, A ;
GORLIN, R ;
FUSTER, V .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1986, 7 (03) :472-478
[2]
ANGIOGRAPHIC PROGRESSION OF CORONARY-ARTERY DISEASE AND THE DEVELOPMENT OF MYOCARDIAL-INFARCTION [J].
AMBROSE, JA ;
TANNENBAUM, MA ;
ALEXOPOULOS, D ;
HJEMDAHLMONSEN, CE ;
LEAVY, J ;
WEISS, M ;
BORRICO, S ;
GORLIN, R ;
FUSTER, V .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1988, 12 (01) :56-62
[3]
DIFFERENTIAL EXPRESSION OF TISSUE FACTOR PROTEIN IN DIRECTIONAL ATHERECTOMY SPECIMENS FROM PATIENTS WITH STABLE AND UNSTABLE CORONARY SYNDROMES [J].
ANNEX, BH ;
DENNING, SM ;
CHANNON, KM ;
SKETCH, MH ;
STACK, RS ;
MORRISSEY, JH ;
PETERS, KG .
CIRCULATION, 1995, 91 (03) :619-622
[4]
Plaque erosion is a major substrate for coronary thrombosis in acute myocardial infarction [J].
Arbustini, E ;
Dal Bello, B ;
Morbini, P ;
Burke, AP ;
Bocciarelli, M ;
Specchia, G ;
Virmani, R .
HEART, 1999, 82 (03) :269-272
[5]
Regional remodeling of atherosclerotic arteries: A major determinant of clinical manifestations of disease [J].
Birnbaum, Y ;
Fishbein, MC ;
Luo, H ;
Nishioka, T ;
Siegel, RJ .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1997, 30 (05) :1149-1164
[6]
REMODELING OF CORONARY-ARTERIES IN HUMAN AND NONHUMAN-PRIMATES [J].
CLARKSON, TB ;
PRICHARD, RW ;
MORGAN, TM ;
PETRICK, GS ;
KLEIN, KP .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1994, 271 (04) :289-294
[7]
DAVIES MJ, 1993, BRIT HEART J, V69, P377
[8]
FALK E, 1983, BRIT HEART J, V50, P127
[9]
CORONARY PLAQUE DISRUPTION [J].
FALK, E ;
SHAH, PK ;
FUSTER, V .
CIRCULATION, 1995, 92 (03) :657-671
[10]
Coronary plaque erosion without rupture into a lipid core - A frequent cause of coronary thrombosis in sudden coronary death [J].
Farb, A ;
Burke, AP ;
Tang, AL ;
Liang, YH ;
Mannan, P ;
Smialek, J ;
Virmani, R .
CIRCULATION, 1996, 93 (07) :1354-1363