Key Points
- To evaluate whether acute occlusive coronary thrombi serve as the primary pathogenic cause of acute myocardial infarction.
- Analyzed 100 hearts from consecutive patients with clinically proven and histologically confirmed myocardial infarction in a prospective postmortem study.
- Evaluated the location, type, and size of infarcts alongside coronary stenosis degree, heart weight, and the presence or location of occlusive thrombi.
- Acute occlusive thrombi were absent in 55% of coronary arteries supplying infarcted myocardium, whereas 45% of cases had thrombi (nearly all in the supplying artery).
- Thrombi occurred more frequently in transmural infarcts (55%) compared to infarcts spanning the inner two-thirds of the wall (30%) or subendocardial infarcts (27%).
- Most infarcts developed with >70% coronary stenosis, but infarct size was independent of the distribution, length, and number of severe stenoses.
Structured PICO
PPopulation100 hearts from patients who had clinically proved myocardial infarction with histologic confirmation
OOutcomePresence and location of acute occlusive coronary thrombi in relation to myocardial infarctionsurrogate
This historical autopsy study challenged the concept that acute occlusive coronary thrombi are the primary cause of myocardial infarction, finding that 55% of infarcted hearts lacked an occlusive thrombus in the supplying artery.