Sudden coronary death: The occurrence of platelet aggregates in the epicardial arteries of man

  • J.W. Hærem
    Address for reprint requests: Dr. Jørgen w. Hærem, Ullevål Hospital, Department of Pathology, Oslo 1 Norway.
    Department of Pathology, Ullevål Hospital, University of Oslo, Oslo Norway
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      This study was carried out in order to explore whether platelet aggregates in the human coronary circulation might play a role in the pathogenesis of sudden coronary death.
      Eighty-one post mortem cases were selected and grouped according to mode of death and previous illnesses. Forty-seven patients had died suddenly and unexpectedly of coronary artery disease. Twenty-one patients had had chronic coronary disease, but had died of various non-cardiac diseases, and 13 patients had died without known coronary or cardiac disease.
      The epicardial arteries were cross-sectioned and microscopically examined for platelet aggregates.
      Platelet aggregates in the epicardial arteries were larger and more frequent in patients who had suddenly died of coronary disease than in patients with no coronary disease.
      Arteries with recent thrombi of macroscopic as well as of microscopic size tended to contain many and large platelet aggregates. Arteries with extensive atherosclerotic stenosis tended to contain larger platelet aggregates than those with less extensive stenosis.
      The overweight of platelet aggregates in patients who had suddenly died could partly be explained by a higher prevalence of arteries with acute thrombi and more extensive atherosclerotic stenosis in the coronary arteries of these patients.
      Platelet aggregates may cause functional disturbances or tissue injury by impeding the microcirculation. In some instances of sudden coronary death, where acute lesions in the epicardial arteries are small or absent, platelet aggregates in the coronary circulation may play a role in the pathogenesis of the fatal event.


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