Platelet aggregates in intramyocardial vessels of patients dying suddenly and unexpectedly of coronary artery disease

  • J.W. Hærem
    Reprint requests to: Dr. Jørgen W. Hærem, Ullevål Hospital, Krohgstøtten, Oslo 1 Norway.
    Ullevål Hospital, Department of Pathology, University of Oslo, Oslo Norway
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      The present study was carried out in order to explore if platelet aggregates in the intramyocardial vessels of man could play a role in the pathogenesis of sudden coronary death, especially in patients with no major lesion in the epicardial arteries. The vessels of the conduction system were of particular interest.
      The intramyocardial vessels of 54 patients were examined by microscopical screening of standard myocardial sections. The sinus- and atrioventricular nodes, the bundle of His, and the bundle branches were included in the sections. Twenty-seven patients died suddenly and unexpectedly of coronary artery disease. Sixteen patients had chronic coronary disease, but died of non-cardiac diseases. Eleven patients died without known coronary disease.
      Among patients who had no acute major lesion in the epicardial arteries, those who died suddenly of coronary disease had the highest number of intramyocardial arteries with platelet aggregates. Compared with the chronic coronary patients the difference was statistically significant.
      The platelet aggregates did not occur particularly in the vessels of the conduction system in any disease group.
      In some instances of sudden coronary death with no major acute lesion in the epicardial arteries, a hampering of the intramyocardial circulation by platelet aggregates possibly plays a role in the pathogenesis of the fatal event.


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