What is the clinical evidence from this study?

Study design: Observational. Population: Sudden coronary death (n=111). Intervention: Plaque erosion vs. Plaque rupture. Primary outcome: Prevalence of late-stage thrombi (p=<0.0001).

What does this research mean for the field?

Coronary plaque erosions in sudden death victims have a significantly higher prevalence of late-stage organizing thrombi compared to plaque ruptures. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To determine how stages of coronary thrombus healing relate to underlying plaque morphologies in victims of sudden coronary death.

September 20, 2026Journal of the American College of CardiologyOpen Access

Relationship of Thrombus Healing to Underlying Plaque Morphology in Sudden Coronary Death

Q: What are the key findings of this study?

Plaque erosions in sudden coronary death victims were associated with a significantly higher prevalence of late-stage thrombi compared to plaque ruptures (88% vs 54%, p < 0.0001).

Q: What does this research mean for the field?

Coronary plaque erosions in sudden death victims have a significantly higher prevalence of late-stage organizing thrombi compared to plaque ruptures. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To determine how stages of coronary thrombus healing relate to underlying plaque morphologies in victims of sudden coronary death.

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Key result

Plaque erosions linked to ~63% higher prevalence of late-stage thrombi versus ruptures in sudden death.

P<0.0001
n=111

Why the study?

Differences in thrombus healing between ruptured and eroded plaques in sudden coronary death are not well understood, despite clinical challenges in distinguishing these lesions.

Population

111 sudden coronary death victims with coronary lesions containing thrombi

Comparison

Thrombus healing in ruptured plaques vs eroded plaques

Design

Observational morphometric analysis of coronary lesions from Medical Examiner's Office

Authors

MKMiranda C.A. KramerUniversity Medical Center Groningen SRSaskia Z.H. RittersmaUtrecht University RWRobbert J. de WinterNorthwestern University

Discussion

Member takes

Implication

Postmortem study demonstrates distinct thrombus healing patterns across plaque morphologies in sudden coronary death, indicating episodic thrombosis precedes fatal occlusion.

Key Points

To determine how stages of coronary thrombus healing relate to underlying plaque morphologies in victims of sudden coronary death.
Histopathological analysis of culprit coronary artery segments obtained from sudden coronary death autopsy cases.
Classification of underlying plaque morphology into plaque rupture, plaque erosion, or calcified nodules.
Staging of luminal thrombi by cellular composition into acute, organizing, or fully healed phases.
Healed and organizing thrombi frequently coexist with acute thrombotic occlusions at sites of both plaque rupture and plaque erosion, demonstrating that subclinical thrombotic episodes recur before fatal events.
Plaque rupture lesions correlate with extensive lipid cores and intense inflammatory cell infiltration during healing, whereas plaque erosion exhibits proteoglycan-rich matrices with smooth muscle cell proliferation.

Study Design

Type

Observational (n=111)

PICO

Population

111 sudden coronary death victims with 115 culprit plaques (65 ruptures, 50 erosions) analyzed for differences in thrombus healing.

Exposure / Comparator

Plaque erosion vs Plaque rupture

Primary Outcome

Prevalence of late-stage thrombi, p=<0.0001

Main Result

Absolute Event Rate: 88% vs 54%

p-value: p=<0.0001

Cite This Study

Kramer et al. (2009) conducted an observational in Sudden coronary death (n=111). Plaque erosion vs. Plaque rupture was evaluated on Prevalence of late-stage thrombi (p=<0.0001). Plaque erosions in sudden coronary death victims were associated with a significantly higher prevalence of late-stage thrombi compared to plaque ruptures (88% vs 54%, p < 0.0001).

synapsesocial.com/papers/6ab04d15cdc128587b47ec92 https://doi.org/10.1016/j.jacc.2009.09.007

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Implication

Postmortem study demonstrates distinct thrombus healing patterns across plaque morphologies in sudden coronary death, indicating episodic thrombosis precedes fatal occlusion.

Relationship of Thrombus Healing to Underlying Plaque Morphology in Sudden Coronary Death

Discussion

Member takes

Implication

Key Points

Study Design

PICO

Main Result

Cite This Study

Relationship of Thrombus Healing to Underlying Plaque Morphology in Sudden Coronary Death

Discussion

Member takes

Implication

Key Points

Study Design

PICO

Main Result

Cite This Study

Also Consider

Also Consider