Fatality of myocardial infarction in relation to the coronary anatomy: role of culprit lesion location.
OBJECTIVE
We set out to study the effect of the location of the culprit coronary lesion on myocardial infarction (MI) fatality by combining data from MI survivors in the coronary care unit (CCU) and autopsied patients with pre-hospital fatal MI.


METHODS
We studied two simultaneous series of men under 70 years with fatal pre-hospital MI (n = 36) and men admitted for acute ST-elevation-MI (n = 92). The culprit lesion was identified by the presence of thrombus at autopsy and by coronary angiography in patients admitted to the CCU.


RESULTS
The culprit lesion was located in the right coronary artery (RCA) in 22 (61%) of 36 men with fatal MI compared to 30 (33%) of 92 men with non-fatal MI (P = 0.01). Seventy-three percent of fatal RCA occlusions were proximal as opposed to only 30% of non-fatal RCA occlusions (P < 0.001). Forty-four percent of all fatal MI were due to proximal RCA occlusion as opposed to only 10% of non-fatal MI (P < 0.005).


CONCLUSIONS
Proximal RCA occlusions were very often found among men with fatal pre-hospital MI, whereas left-sided coronary occlusions were significantly more frequent in hospital-admitted survivors of MI. Left-sided coronary occlusions may be associated with a more favourable pre-hospital phase of acute MI compared to proximal RCA occlusions.
Mikkelsson
Jussi
J
University of Tampere, Medical School, Dept of Forensic Medicine and Research Unit of the Centre of Clinical Chemistry of Tampere University Hospital, Finland. Jussi.Mikkelsson@dnainternet.net
Eskola
Markku
M
Nikus
Kjell
K
Pietilä
Kari
K
Karhunen
Pekka J
PJ
Niemelä
Kari
K
D001344:Autopsy; D017023:Coronary Angiography; D003328:Coronary Thrombosis / Q000473:pathology*; D003331:Coronary Vessels / Q000473:pathology*; D004562:Electrocardiography; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality* / Q000473:pathology*