Morphological Findings in the Coronary Arteries in Fatal Coronary Artery Disease

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Atherosclerotic coronary artery disease (CAD) is the most common cause of death in the Western world. One American dies every minute because of atherosclerotic CAD. In the USA alone, about 6 million persons have symptomatic myocardial ischemia because of atherosclerotic CAD. About 250000 coronary artery bypass grafting operations were performed in 1990 in the USA and about 300000 coronary angioplasty procedures. The cause of atherosclerosis is now clear. The evidence is overwhelming that atherosclerosis is a cholesterol problem. The higher the blood total cholesterol level (specifically the low-density lipoprotein level) the greater the chance of developing symptomatic CAD, the greater the chance of having fatal CAD, and the greater the extent of the atherosclerotic plaques. Furthermore, lowering the blood total cholesterol level decreases the chances of having symptomatic or fatal CAD and the greater the chance that some atherosclerotic plaques will actually become smaller, i.e. regress. Although the coronary arteries have been examined by visual inspection at necropsy for over 100 years, only in recent years has the extent of the atherosclerotic process in the coronary arteries in patients with symptomatic or fatal CAD become appreciated. This chapter initially reviews the status of the major epicardial coronary arteries in various subsets of patients with fatal atherosclerotic CAD. It then describes the effects of angioplasty on these arteries, some observations in patients having thrombolytic therapy and coronary bypass, and then various complications of myocardial ischemia.