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Open Access 01-09-2021 | Sudden Cardiac Death | Original Article

Postmortem coronary artery calcium score in cases of myocardial infarction

Authors: Katarzyna Michaud, Virginie Magnin, Mohamed Faouzi, Tony Fracasso, Diego Aguiar, Fabrice Dedouit, Silke Grabherr

Published in: International Journal of Legal Medicine | Issue 5/2021

Abstract

Sudden cardiac death (SCD) related to atherosclerotic coronary artery disease (ACAD) resulting in myocardial infarction is the most prevalent cause of death in western countries. In clinical practice, coronary artery calcium score (CACS) is considered an independent predictor of coronary events, closely related to atherosclerotic burden and is quantified radiologically by the Agatston score being calculated through computed tomography. Postmortem computed tomography (PMCT) allows the visualization and quantification of coronary calcifications before the autopsy. However, it was reported that some patients who died from severe ACAD had a zero CACS in PMCT. In this study, a retrospective evaluation of CACS in adult’s myocardial infarction cases related to ACAD, with available CACS and histological slides of coronary arteries, was performed in order to gain a deeper understanding of coronary calcifications and their role in myocardial infarction cases. The CACS was calculated by using the software Smartscore 4.0 after the radiological examination on a 64-row CT unit using a specific cardiac protocol. Thirty-six cases were identified out of 582 autopsies, recorded during a 2-year study period (29 men, 7 women; age 56.3 ± 11.7). CACS was 0–10 in 5 cases (5 men, 44.8 ± 13.7), 11–100 in 8 cases (6 men, 2 women, 53.1 ± 7.7), 101–400 in 13 cases (11 men, 2 women, 57.4 ± 9.6), and > 400 in 10 cases (9 men, 1 woman, 63.1 ± 11.9). Coronary thrombosis was found in 28 cases, histologically identified as plaque erosions in 6 cases and as plaque ruptures in 22 cases. Statistical analyses showed that CACS increases significantly with age (p-value < 0.05) and does not show significant correlation with gender, body weight, body mass index, and heart weight. CACS was significantly higher in plaque ruptures than in plaque erosions (p-value < 0.01). Zero or low CACS on unenhanced PMCT cannot exclude the presence of myocardial infarction related to ACAD. This paradoxical discrepancy between imaging and autopsy findings can be explained considering the histological aspect of fatal coronary plaques.

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Title: Postmortem coronary artery calcium score in cases of myocardial infarction
Authors: Katarzyna Michaud
Virginie Magnin
Mohamed Faouzi
Tony Fracasso
Diego Aguiar
Fabrice Dedouit
Silke Grabherr
Publication date: 01-09-2021
Publisher: Springer Berlin Heidelberg
Keywords: Sudden Cardiac Death
Autopsy
Myocardial Infarction
Thrombosis
Published in: International Journal of Legal Medicine / Issue 5/2021
Print ISSN: 0937-9827
Electronic ISSN: 1437-1596
DOI: https://doi.org/10.1007/s00414-021-02586-z

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Postmortem coronary artery calcium score in cases of myocardial infarction

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