Quantitative comparison of amounts of cross-sectional area narrowing in coronary endarterectomy specimens in patients having coronary artery bypass grafting to amounts of narrowing in the same artery in patients with fatal coronary artery disease studied at necropsy.
This study compares the amounts of cross-sectional area narrowing of the right coronary artery (RCA) in patients having endarterectomy of this artery at the time of coronary artery bypass grafting (CABG) to the amounts of narrowing in the same artery at necropsy in patients with fatal coronary artery disease (CAD). We examined histologically each 5-mm segment of endarterectomy specimens of the RCA in 39 patients having this procedure at the time of CABG and compared findings in them to the amounts of narrowing of 5-mm segments of the RCA in 141 patients with fatal CAD studied at necropsy. Of the 564 five-mm RCA segments in the endarterectomy patients, 371 (66%) were narrowed >75% in cross-sectional area by atherosclerotic plaque: another 112 (20%), 51% to 75%; 64 (11%), 26% to 50%, and 17 (3%), 1% to 25%. In contrast, of 2,699 five-mm segments of the RCA in 141 patients with fatal CAD, 1,217 (45%) were narrowed >75% in the cross-sectional area; another 966 (36%), 51% to 75%; 405 (15%), 26% to 50%, and 114 (4%), 1% to 25% by plaque. In conclusion, the amounts of severe narrowing found in coronary endarterectomy specimens excised at the time of CABG in live patients is at least as great as that found using the same technique in patients with fatal CAD studied at necropsy. This observation suggests that an even greater emphasis should be placed on primary prevention of atherosclerotic events and, indeed, of atherosclerotic plaques.
Roberts
William Clifford
WC
Department of Pathology, Baylor University Medical Center, Dallas, Texas, USA. w.c.roberts@baylorhealth.edu
Turnage
Thomas Alpert
TA
Whiddon
Lonnie Lee
LL
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D003331:Coronary Vessels / Q000473:pathology* / Q000601:surgery; D003643:Death; D004691:Endarterectomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index