Mode of death, frequency of healed and acute myocardial infarction, number of major epicardial coronary arteries severely narrowed by atherosclerotic plaque, and heart weight in fatal atherosclerotic coronary artery disease: Analysis of 889 patients studied at necropsy

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Mode of death, frequency of a healed or an acute myocardial infarct, or both, number of major epicardial coronary arteries severely narrowed by atherosclerotic plaque, and heart weight were studied at necropsy in 889 patients 30 years of age or older with fatal atherosclerotic coronary artery disease. No patient had had a coronary bypass operation or coronary angioplasty. The 889 patients were classified into four major groups and each major group was classified into two subgroups: 1) acute myocardial infarct without (306 patients) or with (119 patients) a healed myocardial infarct; 2) sudden out of hospital death without (121 patients) or with (118 patients) a healed myocardial infarct; 3) chronic congestive heart failure with a healed myocardial infarct without (137 patients) or with (33 patients) a left ventricular aneurysm; and 4) sudden inhospital death without (20 patients) or with (35 patients) unstable angina pectoris.The mean age of the 687 men (77%) was 60 ± 11 years, and of the 202 women (23%), 68 ± 13 years (p = 0.0001). Although men included 77% of all patients, they made up approximately 90% of the out of hospital (nonangina) sudden death group. The frequency of systemic hypertension and angina pectoris was similar in each of the four major groups. The frequency of diabetes mellitus was least in the sudden out of hospital death group and similar in the other three major groups.The mean heart weight and the percent of ptients with a heart of increased weight were highest in the chronic congestive heart failure group; values were lower and similar in the other three major groups. All patients in the chronic congestive heart failure group (by definition) had a healed left ventricular infant, which was similar in frequency in the other three major groups. The percent of patients in whom three or four of the four major coronary arteries were severely narrowed (>75% in cross-sectional area) by atherosclerotic plaque was highest in the unstable angina subgroup and similar in all other major groups.