Subendocardial infarction in the aged can be pathologically classified into three types, which are consistently associated with balanced severe proximal coronary stenosis and a high incidence of hypertension.
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Subendocardial infarction subtyping by coronary anatomy in the elderly is hypothesis-generating; leaves open whether it informs management.
A total of 8 cases of subendocardial infarction was presented. Pathological analyses classified them into 3 subgroups; pure, mixed and scattered types. In the pure type, the circumferential subendocardial lesion was fresh and homogeneous with strict limitation within the inner 1/3 or 1/2 of the left ventricular wall. The mixed type showed fresh and old lesions with more extensive involvement though most portions were located within the inner 1/2 layer. The scattered type showed numerous small fibrotic foci densely accumulated in the inner 1/2 layer. The common characteristic finding in 3 types was a balanced severe stenosis of both right and left coronary arteries with an atheromatous plaque narrowing the right coronary ostium. The pure type had the stenosis only at the proximal parts, the mixed type had more extensive stenotic lesions and the scattered type had the stenosis located distally. There was a high incidence of hypertension. The balanced proximal stenosis and hypertension were considered to be related with diffuse circumferential infarction.
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Sugiura et al. (1969) studied this question.
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