Erosion Pathology and Sudden Cardiac Death

I mentioned the clots that form in coronary arteries can be characterized as young or old in my previous blog. When someone dies suddenly from sudden cardiac death and they undergo an autopsy, if a clot is found, it can be analyzed and its age determined. Older thrombi defined as more than one day old were found more often and are believed to have a higher risk of death than thrombi less than one day old. Women were found to have older thrombi more often than men.

Dr. Virmani found that often a different type of pathology was found in sudden cardiac death — that of erosion of the lining of the artery which is made up of endothelial cells. This differs from the plaque-rupture scenario. Erosion pathology was found more often in women and it is speculated that this pathology which leads to older thrombus may be the reason for higher death rates in women than men.

In the study cited in my last blog, older thrombi were found in 79 of the 115 culprit plaques or 69%. In ruptures, the split was 50-50 between older and younger clots. In erosion pathology, 85% of the thrombus was older than one day. Further it was found that in women less than 50 years of age, 80% of those studied had erosion pathology. This is also true of young men. In men under 40 years of age who die suddenly and are studied, 50% of the lesions are of the erosion pathology. After that, plaque rupture predominates.

It may be those young women who complain of chest discomfort that is not definable by testing may actually have this phenomenon which will be very difficult to diagnosis with today’s tools. Smoking and birth control pills may also increase this risk. Treatments may need to be tailored to women and young men to increase artery size by vasodilating drugs and better use of antiplatelet drugs. In addition, a C reactive protein lab may be a useful test to determine if inflammation is occurring. You will remember in a previous blog that Crestor was given to patients with normal cholesterol and high CRP and that they fared significantly better than those that took placebo. The FDA extended Crestor’s indication to these people. Crestor’s drug effect maybe preventing this erosion pathology from taking place and leading to myocardial infarction and sudden cardiac death.

We continue to learn and to form treatments. Coronary disease continues to be the leading cause of death in the US. We need to do better.

Tags: clots, Myocardial Infarction, sudden cardiac death, thrombi
Posted in Coronary Artery Disease, Myocardial Infarction | 3 Comments »