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Microembolic Events Linked to Sudden Cardiac Death

Plaque erosion is dominant histopathology in clot embolization causing sudden cardiac death

THURSDAY, Nov. 26 (HealthDay News) -- Microemboli and microvascular obstruction are common in acute coronary thrombosis and sudden cardiac death, according to a study in the Dec. 1 issue of the Journal of the American College of Cardiology.

Robert S. Schwartz, M.D., of the Minneapolis Heart Institute and Foundation, and colleagues studied 44 hearts from sudden coronary death patients who died at a mean age of 51 years.

The researchers identified 26 plaque ruptures and 21 erosions, and a mean of 4.5 microemboli per heart. They found that eroded plaques were primarily responsible for microemboli and microvascular obstruction and that the left anterior descending coronary artery was the most common site for microemboli and occluded intramyocardial vessels. They also found that all vessels contained fibrin and platelets.

"Although mechanisms were not evident from this study, the implications are that epicardial atherosclerotic plaque structure and morphology may preferentially predispose to microembolic events," the authors write. "Similarly, iatrogenic plaque disruption occurs with percutaneous coronary intervention of acute coronary syndromes, and microembolic microvascular obstruction is a major clinically recognized cause of angiographic no-reflow."

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