Sudden unexpected death in young adults. Discrepancies between initiation of acute plaque complications and the onset of acute coronary death

AIMS: To study the time relationship between the onset of coronary thrombosis and sudden unexpected cardiac death in young adults. METHODS AND RESULTS: Hearts of 11 young adults (< or = 35 years), who had died within 1h after onset of symptoms and presented with a coronary thrombotic occlusion were studied retrospectively for the type of underlying plaque complication and the time of onset of thrombus formation. In all cases tissue blocks were taken from the occluded artery and sectioned for microscopic evaluation. Of 11 culprit lesions 10 were mainly fibrocellular; only one was lipid-rich. Inflammatory cells were found in all plaques, albeit in highly variable amounts. Plaque erosion had occurred in nine; deep ruptures in two. Analysis of the plaque-related occluding thrombus revealed fresh thrombosis in three (both ruptured plaques and one erosion); the other eight, however, showed occlusion with different histological stages of organization of thrombus. CONCLUSIONS: Despite strict inclusion criteria for sudden death in these young adults, the majority must have had plaque instability for some time, since thrombus formation had occurred at least days to weeks prior to the acute event.