Arteriosclerosis of Coronary Arteries in Sudden, Unexpected Deaths

PERPER, JOSHUA A. M.D., LL.B., M.SC.
KULLER, LEWIS H. M.D., DR. P.H.
COOPER, MALCOLM M.D.

From the Department of Forensic Pathology, Allegheny County, Pittsburgh, Pennsylvania, and Department of Pathology, University of Pittsburgh School of Medicine; Department of Epidemiology, University of Pittsburgh School of Public Health; the Institute of Forensic Sciences, Duquesne University School of Law, Pittsburgh, Pennsylvania; Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania; and the Department of Nuclear Medicine, University of Maryland Hospital, Baltimore, Maryland.

Circulation 52(6):p III-33, December 1975.

The authors graphically studied the topographic pattern and severity of coronary arteriosclerosis in arteriosclerotic heart disease (ASHD) sudden deaths using an improved technique involving in toto removal and decalcification of the main coronary tree. The study involved 171 cases of ASHD sudden death and 154 deaths from other causes. White males were the most severely affected group. The majority of the ASHD deaths had three or four major coronary vessels showing greater than 75% luminal stenosis; single-artery disease was a rare occurrence. The intra- and interarterial pattern of coronary stenosis was equally severe and diffuse, with the exception of the arteries to SA and AV nodes. No small intramyocardial blood vessel disease was evident. Severe chronic coronary stenosis was associated with a high incidence of old myocardial infarction. The anatomical and pathological pattern of coronary stenosis in ASHD deaths appears to have ominous therapeutic implications.