Histological classification of atherosclerosis and correlation with ischemic heart disease: A autopsy based study
Keywords:
Coronary artery disease, Acute myocardial infarction, Myocardial fibrosis, Coronary artery,
Abstract
Background: There is an ever increasing trend of rise of coronary artery disease (CAD) in India and globally. The grading of coronary atherosclerotic lesions is important as it correlates with significant cardiac lesions like acute myocardial infarction (MI), myocardial fibrosis and left ventricular hypertrophy (LVH) etc. To study the same in living subjects is difficult, hence autopsy studies are done. Our 1 year retrospective study aims at grading the coronary atherosclerotic lesions and correlating the results with simulating studies in India and abroad. Method: The present study was conducted in the Department of Pathology, JLN Medical College, Ajmer (Rajasthan). Duration of study was from January 2011 to December 2011. Total 103 post-mortem heart specimens, irrespective of cause of death were examined grossly and microscopically for extent of coronary artherosclerosis and associated cardiac lesions.Results: Of the 103, males affected was 74.75% and females was 25.24%. Commonest type of atherosclerosis was type III (preatheroma) 40.7%. 55.33% showed significant coronary artery disease (type IV -VIII) with atheroma (type IV) as the commonest lesion (23.30%).Left anterior descending artery (LADA) was most frequently involved vessels (46.6%) followed by right coronary artery (RCA) involvement (41.71%). Least frequently involved vessel was left circumflex artery (LCX) (38.83%). 15% had single vessel involvement whereas 37% & 40% cases had two vessels and three vessels involvement respectively.Conclusion: Maximum cases of significant cardiac lesions were associated with advanced atherosclerotic lesions ie. type VI & type VII lesions. Eccentric lesions were more common than concentric lesions.References
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2. Gaziano TA. Cardiovascular disease in the developing world and its cost effective management. Circulation 2005;112:3547-3553.
3. Beaglehole R, Reddy S, Leeder S. Poverty and human development. The global implications of cardiovascular disease. Circulation 2007;116:1871-1873.
4 . Garg M, Aggarwal A, Kataria S. Coronary Atherosclerosis and Myocardial Infarction. An autopsy study. J Indian Acad Forensic Med.2011;33:971-973
5. Indrayan A. Forecasting vascular disease cases and associated mortality in India. NCMH Background Papers : Burden of Disease in India. National commission on macroeconomics and Health, Government of India; 2005.p.197-215.
6. Bertomeu A, García-Vidal O, Farré X, Galobart A. Preclinical coronary atherosclerosis in a population with low incidence of myocardial infarction: cross sectional autopsy study. BMJ 2003;327:591- 2.
7. Stary HC. Natural History and Histological Classification of Atherosclerotic Lesions: An Update. Arterioscler Thromb Vasc Biol 2000;20;1177-1178.
8. Shirani J, Youseti, Roberts WC. Major cardiac findings at necropsy in 366 American octogenarians. Am J Cardiol, 1995:75,151-156.
9. Mcgill HC, Brown BW. Gorel. et al. Grading stenosis in the right coronary artery. Circulation, 1968;37:460-468.
10. Bhargava MK, Bhargava SK. Coronary atherosclerosis in North Karnataka. Indian J Pathol Microbiol. 1975; 18:65-79.
11. Dhruva GA, Agravat AH, Sanghvi HK. Atherosclerosis of coronary arteries as predisposing factor in myocardial infarction: An autopsy study. Online J Health Allied Scs. 2012 11:1
12. Virmani R, Kolodgie FD, Burke AP, Farb A, Schwartz SM. Lessons from sudden coronary death– A comprehensive morphological classification scheme for atherosclerotic lesions. Arterioscler Thromb Vasc Biol 2000; 20: 1262-75
13. Farb A, Tang AL, Burke AP, Sessums L, Liang Y, Virmani R. Sudden coronary death – Frequency of active coronary lesions, inactive coronary lesions and myocardial infarction. Circulation 1995; 92:1701-9
14. Sudha ML, Sundaram S, Purushothaman KR, Kumar PS, Prathiba D. Coronary atherosclerosis in sudden cardiac death: An autopsy study. Indian J Pathol Microbiol 2009; 52: 486-9.
15. Bharti Jha et al. Incidence of coronary atherosclerosis in different coronary arteries and its relation with myocardial infarction: a randomized study in 300 autopsy heart in tertiary care hospital. International journal of Medical Science and Public Health. 2013;2: 836-839.
16. Shiladeria P et al .Coronary atherosclerosis and myocardial infarction, an autopsy study. NJIRM. 2013;4: 106-108.
Published
2016-05-08
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