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Acute coronary occlusion as a cause of myocardial infarct and sudden coronary heart death

  • Giorgio Baroldi
    Affiliations
    From the Armed Forces Institute of Pathology, Washington, D. C., U.S.A.

    From the National Institutes of Health (Postdoctoral Research Fellowship Award No. FF-458), Bethesda, Md., U.S.A.

    From the Istituto di Anatomia e Istologia Patologica, Università di Milano, Milan, Italy
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      Abstract

      The incidence of acute occlusion was investigated in 208 hospitalized patients dying from acute or recent coagulative necrosis of the myocardium, in 116 cases of sudden, unexpected “coronary” heart death, and in 125 cases of sudden but not unexpected “coronary” heart death. The approximate ages of both the vascular and myocardial lesions and the prior sclerotic reduction of the lumen of the acute or recently occluded vessels were studied and correlated with the corresponding enlargement of the collateral arterial circulation.
      From the high incidence of acute or recent coagulation necrosis and/or sudden heart death without acute occlusion (53, 53, and 54% in the three groups studied), the low incidence of a “coeval” relation between the acute or recent occlusion and the stage of the myocardial damage (23, 22, and 19%, respectively), the high incidence of sclerotic reduction of the lumen in excess of 65 per cent in the acutely or recently occluded vessels (82, 91, and 96%, respectively), and the marked enlargement of the collateral circulation found in this study, it appears that in the so-called myocardial infarct or the sudden “coronary” heart death in the human being, most of the cases develop independently of an acute occlusion and that it is incorrect to apply the term “myocardial infarct” to the lesions. It is also our belief that the acute or recent thrombosis occurring in most of the instances should not be considered as the cause of the acute or recent myocardial coagulative necrosis or sudden death or both, but rather as the result of particular hemodynamic conditions existing in and around the involved vessel.
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