title: Plaque erosion is a major substrate for coronary thrombosis in acute myocardial infarction.
abstract: OBJECTIVE
  To evaluate the prevalence of plaque erosion as a substrate for coronary thrombosis.
  
  
  METHODS
  Pathological study in patients with acute myocardial infarction not treated with thrombolysis or coronary interventional procedures.
  
  
  METHODS
  298 consecutive patients (189 men, mean (SD) age 66 (11) years; 109 women, 74 (8) years) dying in hospital between 1984 and 1996 from acute myocardial infarction, diagnosed by ECG changes and rise in cardiac enzymes.
  
  
  METHODS
  Histopathological determination of plaque erosion as substrate for acute thrombosis; location and histological type of coronary thrombosis; acute and healed myocardial infarcts; ventricular rupture.
  
  
  RESULTS
  Acute coronary thrombi were found in 291 hearts (98%); in 74 cases (25%; 40/107 women (37.4%) and 34/184 men (18.5%); p = 0.0004), the plaque substrate for thrombosis was erosion. Healed infarcts were found in 37.5% of men v 22% of women (p = 0.01). Heart rupture was more common in women than in men (22% v 10.5%, p = 0.01). The distribution of infarcts, thrombus location, heart rupture, and healed infarcts was similar in cases of plaque rupture and plaque erosion.
  
  
  CONCLUSIONS
  Plaque erosion is an important substrate for coronary thrombosis in patients dying of acute myocardial infarction. Its prevalence is significantly higher in women than in men.
authors.affiliation: Department of Pathology, IRCCS-Policlinico San Matteo, Via Forlanini 16, 27100 Pavia, Italy. e.arbustini@smatteo.pv.it
authors.forename: E
authors.initials: E
authors.lastname: Arbustini
authors.forename: B
authors.initials: B
authors.lastname: Dal Bello
authors.forename: P
authors.initials: P
authors.lastname: Morbini
authors.forename: A P
authors.initials: AP
authors.lastname: Burke
authors.forename: M
authors.initials: M
authors.lastname: Bocciarelli
authors.forename: G
authors.initials: G
authors.lastname: Specchia
authors.forename: R
authors.initials: R
authors.lastname: Virmani
mesh_terms: D000368:Aged; D002921:Cicatrix / Q000209:etiology; D003324:Coronary Artery Disease / Q000150:complications* / Q000473:pathology; D003328:Coronary Thrombosis / Q000150:complications* / Q000473:pathology; D005260:Female; D006342:Heart Rupture, Post-Infarction / Q000209:etiology; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology*; D012737:Sex Factors