Degrees of coronary arterial narrowing at necropsy in men with large fusiform abdominal aortic aneurysm

Abstract

In 27 patients (mean age at death 72 ± 9 years) with abdominal aortic aneurysm (AAA) ≥5.0 cm in its widest transverse diameter, 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, 12 of the 27 patients (44%) had symptoms of myocardial ischemia: angina pectoris alone in 2, acute myocardial infarction alone in 3, angina pectoris and acute myocardial infarction in 5, and sudden coronary death in 2. Ten of the 27 patients (37%) died from consequences of myocardial ischemia. Six (22%) died from rupture of the AAA. Grossly visible left ventricular necrosis or fibrosis, or both, was present in 15 patients (56%). Of the 27 patients, 23 (85%) 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 2.0 ± 1.3/4.0. Of the 108 major coronary arteries in the 27 patients, 55 (51%) were narrowed >75% in cross-sectional area by plaque. The 4 major coronary arteries in the 27 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 1,475 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, 37, 28, 15 and 3%, respectively. The percentages of 5-mm coronary segments narrowed >75% in cross-sectional area were similar in the right, left anterior descending, and left circumflex coronary arteries. Thus, patients with AAA nearly always have diffuse and severe coronary atherosclerosis.