Amounts of coronary arterial narrowing by atherosclerotic plaque at necropsy in patients with lower extremity amputation

Abstract

In 26 patients (mean age at death 68 ± 9 years) who had undergone amputation (at mean age 63 ± 12 years) of 1 or both lower extremities due to severe peripheral arterial atherosclerosis, the amounts of narrowing at necropsy in the 4 major (left main, left anterior descending, left circumflex, and right) epicardial coronary arteries were determined. During life, 15 of the 26 patients (58%) had symptoms of myocardial ischemia: angina pectoris alone in 1, acute myocardial infarction alone in 5, and angina and/or infarction plus congestive heart failure or sudden coronary death in 9. Twelve of the 26 patients (42%) died from consequences of myocardial ischemia: acute myocardial infarction in 5, sudden coronary death in 3, chronic congestive heart failure in 3, and shortly after coronary bypass surgery in 1. Grossly visible left ventricular necrosis or fibrosis, or both, was present in 21 patients (81%). Of the 26 patients, 24 (92%) had narrowing 76 to 100% in cross-sectional area of 1 or more major coronary arteries by atherosclerotic plaque. The mean number of coronary arteries per patient severely (>75%) narrowed was 2.3 ± 1.0/4.0. Of the 104 major coronary arteries in the 26 patients, 60 (58%) were narrowed >75% in cross-sectional area by plaque. The 4 major coronary arteries in the 26 patients were divided into 5-mm segments and a histologic section, stained by the Movat method, was prepared from each segment. The mean percentages of the resulting 1,322 five-mm segments narrowed in cross-sectional area 0 to 25%, 26 to 50%, 51 to 75%, 76 to 95% and 96 to 100% were 17, 20, 35, 19 and 9%, respectively. The percentages of 5-mm coronary segments narrowed >75% in cross-sectional area were similar in the left anterior descending, left circumflex and right coronary arteries. Thus, patients with peripheral arterial atherosclerosis severe enough to warrant amputation nearly always have diffuse and severe coronary atherosclerosis at the time of necropsy.