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Vol. 31. Issue 2.
Pages 63-72 (March - April 2019)
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Vol. 31. Issue 2.
Pages 63-72 (March - April 2019)
Original article
DOI: 10.1016/j.artere.2019.02.003
Histology of atherosclerotic plaque from coronary arteries of deceased patients after coronary artery bypass graft surgery
Histología de la placa de ateroma en arterias coronarias de fallecidos después de una revascularización miocárdica quirúrgica
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Yanet Pérez Soría, Vivian A. Herrera Moyaa, Ileana Puig Reyesb, Francisco L. Moreno-Martínezb,
Corresponding author
flmorenom@yahoo.com

Corresponding author.
, Rosa Bermúdez Alemána, Teresita Rodríguez Millaresa, Alexei Fleites Medinab
a Universidad de Ciencias Médicas de Villa Clara, Villa Clara, Cuba
b Cardiocentro Ernesto Che Guevara, Villa Clara, Cuba
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Tables (4)
Table 1. Demographic and clinical characteristics and causes of death in study patients (n=21).
Table 2. Characteristics of the atherosclerotic lesion in relation to anatomical and clinical variables.
Table 3. Permeability of coronary arteries in morphological observations (n=242).
Table 4. Graft-related variables.
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Abstract
Background and aim

Ischaemic heart disease is an important health problem. The characteristics of atherosclerotic plaques determine patient outcome. The aim of this study was to determine the histological grade of coronary atherosclerotic lesions in deceased patients after coronary artery bypass graft surgery, and to identify the complications of the severe plaques.

Method

A descriptive, cross-sectional, prospective study was carried out on 21 anatomical pieces of deceased patients over a period of 3 years. The epicardial coronary arteries were sectioned transversally every 1cm, and the odd numbered fragments and the regions of the anastomosis with the grafts were selected. They were embedded in paraffin, stained with haematoxylin-eosin, and the histological slides were studied using an Olympus BHM microscope.

Results

An age over 50 years (85.7%), male gender (81.0%), and smoking (66.7%) predominated. Peri-operative infarction (38.1%) and cardiogenic shock (33.3%) were the main direct causes of death. The majority of the grafts were of venous origin (64.6%), and 149 lesions were detected, of which 116 (77.8%) were severe plaques, and 47.4% of them were located in the left anterior descending artery. The large majority (81.9%) of the lesions were located in the arterial segments proximal to the graft. A total of 255 histological complications were detected in the severe plaques, with 75.0% showing calcification. Hypertensive patients had more plaques with more complications, but no statistically significant association was found between these variables.

Conclusions

Severe plaques predominated, mostly located in the proximal segments of the coronary arteries, and the left anterior descending was the most affected artery. Calcification was the most observed complication in the severe plaques.

Keywords:
Atherosclerosis
Coronary lesions
Autopsy
Ischaemic heart disease
Coronary artery bypass graft surgery
Resumen
Introducción y objetivos

La cardiopatía isquémica constituye un importante problema de salud. Las características de las placas de ateroma condicionan la evolución de los pacientes. El objetivo fue determinar el grado histológico de las lesiones ateroscleróticas de las coronarias en fallecidos tras una revascularización miocárdica quirúrgica e identificar las complicaciones de las placas graves.

Métodos

Estudio descriptivo, transversal, prospectivo, de 21 piezas anatómicas de fallecidos durante un período de 3 años. Las coronarias epicárdicas se seccionaron transversalmente cada 1cm y se seleccionaron los fragmentos impares y las regiones de la anastomosis con los injertos. Se incluyeron en parafina, se colorearon con hematoxilina-eosina y las láminas histológicas se describieron con un microscopio Olympus BHM.

Resultados

Predominaron la edad mayor de 50 años (85,7%), el sexo masculino (81,0%) y el tabaquismo (66,7%). El infarto perioperatorio (38,1%) y el shock cardiogénico (33,3%) fueron las principales causas directas de muerte. La mayoría de los injertos fueron venosos (64,6%). Se detectaron 149 lesiones: 116 (77,8%) fueron placas graves y el 47,4% de ellas se localizaban en la descendente anterior. El 81,9% de las lesiones se localizaron en los segmentos arteriales proximales al injerto. Se identificaron 255 complicaciones histológicas en las placas graves; el 75,0% presentó calcificación. Los hipertensos tenían más placas con más complicaciones, pero no se encontró relación estadística significativa entre estas variables.

Conclusiones

Predominaron las placas graves, localizadas mayoritariamente en los segmentos proximales de las coronarias, y la descendente anterior fue la más afectada. La calcificación fue la complicación más observada en las placas graves.

Palabras clave:
Aterosclerosis
Lesiones coronarias
Necropsia
Cardiopatía isquémica
Revascularización miocárdica quirúrgica

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