Morphological changes of coronary arteries in cases of sudden death due to cardiac causes - An autopsy-based 10-year retrospective study

Abstract

Introduction: Ischemic heart disease (IHD) is the most common cause of cardiac deaths worldwide, mainly due to atherosclerosis. Prevalence of atherosclerosis evaluation, in an autopsy-based study, can be a valuable tool on subjects who died of cardiac causes. With this hypothesis, we conducted this 10-year retrospective study on the hearts of subjects who died due to cardiac causes. Materials and Methods: This study was conducted from January 2010 to May 2020 at Department of Pathology, Hassan Institute of Medical Sciences, Hassan, Karnataka. Autopsy was conducted at our hospital in the deceased patients who died of suddenly due to cardiac causes. Standard procedures were followed for the removal of intact heart. Heart specimens were sent to our department for histopathological analysis. After fixation in 10% formalin, specimens of the heart were examined in detail. Heart specimens were weighed and measured. The three main coronary arteries were identified and dissected out according to the standard guidelines. These arteries were carefully examined for any histological evidence of atherosclerosis and associated pathological lesions. After detailed study, the lesions were graded according to the classification given by the American Heart Association from Grade I to Grade VI and coronary luminal narrowing by White and Edwards method. Results: Evaluation of a total of 682 autopsy cases was done. In the evaluation, 574 cases were due to sudden cardiac caused deaths. 436 (76.03%) subjects had evidence of atherosclerosis in coronary arteries. In our study, 468 (81.53%) were male and remaining 106 (18.46%) were female. The most commonly involved coronary artery was left anterior descending coronary artery (LADA, 412 cases, 71.74%). Triple-vessel disease was found in 118 cases (20.55%) of subjects. Conclusion: In Indian population, atherosclerosis of the coronary arteries begins at a younger age. Therefore, thorough screening for the same should begin at an early age. Our study showed alarmingly high prevalence of atherosclerosis in coronary arteries, especially in the LADA. Coronary atherosclerosis is an important risk factor for IHDs in both sexes, even though the incidence of atherosclerosis is more common in males when compared to females.

Keywords

• atherosclerosis
• autopsy
• coronary vessels
• left anterior descending coronary artery