Objective Compare the morphology of atherosclerotic plaquesmgiographically and histopathologically in acute myocardialmfarction m order to accumulate experience in recognizing plaquerupture and thrombus by angiogrames.Material and methods 16postmortem cases of acute myocardial infarction were studied.The coronary arteries were romoved en block,filled with barium the lumen and ridiographed.Then the arteries wereontinuously insetted and routin HE sections were made.Results 16 cases had plaque ruptures and thrombi.Among the total98 blocks,21 had plaque ruptures on which 20 thrombiccur(95.23%).while the other 777 unrupured blocks had only 2hrombi(0.25%).The difference was significant(p<0.001).Therupture mostly occur on unstable plaques.The ruptured plaqueswith thrombi had different angiographical morphology withunruptured plaques.The former had irregular borders andunraluminal lucencies;while the Iatter had smooth borders and nointraluminal lucencies.Conclusions Plaque ruprure withthrumbus was the major cause of acute myocardial infarction andthe ruptured plaques with thrombus had different angiographicalapperances with unruptured plaques.
The purpose of this study is to determine whether advancing age andheart failure are independent predictors of increased mortality afrer acutemyocardial infarction(AMI)We reviewed the clinical data of 1068 in-patients(344 senile/724 nonsenile)with AMI.The results showed atypicalpresentations of infarction-related symptoms in the elderly are common,with consequent delay in the diagnosis and treatment The elderly patientshad a high proportion of systemic hypertension(43.9%),non Q wave AM/(36%)and heart failure(35.5%),On the contrast,the proportion of that innonsenile patients were 33%,8Vo and 16.4% respectively.In elderlypatients,several complications:of AMI are more common,asinterventricular septum perforation(2%),cardiogenic shock(19.8%),arthythmia(61.9%).Heart failure was more frequent in patients with leftventricular ejection fraction(LVEF)≤35%,previous heart failure ormyocardial infarction,and anterior location infarction.Those with severecongestive heart failure had a mortality of 33.2% compared with 24.5% forthose with moderate heart failure and 13.51% for those with no heart failurein the first eight weeks.The following factors were associated with anincreased risk of death:older age,longer delay before admission to hospital,no prescription of beta-blaekers and a previous history of infarctionOur data suggested that the prognosis after AMI was directly related toadvaneeing age and the severity of congestive heart failure.Thedevelopment of congestive heart failure was an independent predictor ofdeath.The increasing incidence and mortality were closely related toimpaired myocardial reserve.The present benefits,as pointed out by therecent progress in AMI therapy,must be employed in the treatment of olderinfarcted patients More aggressive management in elderly patients shouldoe evaluated for its potential to reduce mortality.
