Correlation Between the Level od Atherosclerosis and Pathological Features of Coronary Artery Disease: A Study of 100 Autopsy Cases

Year 2023, Volume: 13 Issue: 3, 571 - 576, 11.09.2023

Nurşen TURAN YURTSEVER Süheyla EKEMEN Hüseyin Çetin KETENCİ

https://doi.org/10.33808/clinexphealthsci.1123538

Abstract

Objective: Atherosclerosis is a generalized, chronic disease of large and medium-sized muscular elastic arteries. Relation between intensity of atherosclerosis and coronary artery disease, and risk factors of atherosclerosis could not been revealed completely by autopsy studies. We aimed to renew this shortage of knowledge with our autopsy study prospectively.
Methods: One hundred cases were autopsied within 48 h after death. Atherosclerotic risk factor data were collected including age, gender, height, weight, smoking and any chronic coronary artery disease. Atherosclerosis severity was evaluated macroscopically by examining the inner surfaces of the vascular lumens and revealed with postmortem pathological findings of coronary artery disease.
Results: The mean age was 42 ± 22 years. Seventy-four percent of cases were male, while 26% were female. Smoking duration ranged from 1 to 50 years with a mean duration of 17 ± 12 years. Existence of atherosclerosis in main vessels were also in correlation with age, duration of smoking and BMI (Body Mass Index) (p<.05.) significantly. Existence of coronary artery disease at autopsy were in correlation with existence of atherosclerosis in thoracic aorta, abdominal aorta and subclavian artery significantly (p<.05.), but not in correlation with those in carotid artery (p>.05.).
Conclusion: Atherosclerosis in main arteries except those in carotid artery was a good indicator of coronary artery disease.

Keywords

atherosclerosis, coronary artery disease, forensic pathology, autopsy.

Supporting Institution

None

Thanks

Acknowledgements: We thank Prof. Dr. İsmail Birincioğlu, for their valuable contributions in gathering data of this study. This article is dedicated to the cherished memory of Prof.Dr.İsmail Birincioğlu passed away in 17.03.2022 at the age of 53.

References

• Mitchell RN. Blood Vessels. Kumar V,Abbas AK, Aster JC, editors. Robbins Basic Pathology. Philadelphia, Pennsylvania: Elseiver;2018.p:198-361.
• Lamiaa M. Coronary Artery Disease: Pathogenesis, Progression of Atherosclerosis and Risk Factors. Open J Cardiol Heart Dis, 2018;2 (4):1-7. DOI:10.31031/ojchd.2018.02.000545
• İkinci Keleş A. Sağlık Alanında Kullanılan Kantitatif Yöntem, Stereoloji. Dicle Medical Journal, 2019;46(3):615-621 DOI: 10.5798/dicletip.536434 (Turkish)
• Ambade VN, Godbole HV, Batra AK. Atherosclerosis: A medicolegal tool in exhumed decomposed bodies. The American Journal of Forensic Medicine and Pathology, 2008;29 (3):279-280. DOI: 10.1097/PAF.0b013e31817e792b
• Takei H, Strong JP, Yutani C, Malcom GT. Comparison of coronary and aortic atherosclerosis in youth from Japan and the USA. Atherosclerosis 2005;180:171-179. DOI: 10.1016/j.atherosclerosis.2004.11.014.
• Schulte-Altedorneburg G, Droste DW, Kollár J, Beyna T, Felszeghy S, Módis L, Hegedüs C, Ringelstein EB, Csiba L. Measuring carotid artery stenosis--comparison of postmortem arteriograms with the planimetric gold standard. J Neurol. 2005;252:575-582.DOI: 10.1007/s00415-005-0703-5
• Rohani M, Jogestrand T, Ekberg M, van der Linden J, Källner G, Jussila R, Agewall S. Interrelation between the extent of atherosclerosis in the thoracic aorta, carotid intima-media thickness and the extent of coronary artery disease. Atherosclerosis 2005;179:311-316. DOI: 10.1016/j.atherosclerosis.2004.10.012.
• Takeda Y, Hoshiga M, Tatsugami F, Marinaga I, Takehara K, Hotchi J, Yuki T, Ishihara T, Hanafus T. Clinical significance of calcification in ascending aorta as a marker for the requirement of coronary revascularization. J Atheroscler Thromb. 2009;16:346-354.DOI: 10.5551/jat.no1032
• Yamamoto R, Takasu J, Yokoyama K, Watanabe S, Taguchi R, Itani Y, Ito Y, Yonezawa M, Komiyama N, Masuda Y. Descending aorta wall volume and coronary artery disease: A comparative study using enhanced computed tomography of the chest and coronary angiography. Jpn Circ J, 2000;64:842-847. DOI: 10.1253/jcj.64.842.
• Yorgun H, Hazirolan T, Kaya EB, Canpol at U, Sunman H, Ertugrul O, Ates AH, Aksoy H, Aytemir K, Tokgozoglu L, Kabakci G, Oto A. Aortic atherosclerosis predicts the extent and severity of coronary atherosclerosis detected by multidedektor computed tomography coronary angiography. Angiology 2010;61(7):627-637. DOI: 10.1177/0003319710362976.
• Canogullari Kul G, Balci TG. Arteriosclerosis and its frequency in respect with macroscopic findings inmedicolegal autopsies. The Bulletin of Forensic Medicine 2004;9(3):69-73
• Adraktas DD, Brasic N, Furtado AD, Cheng SC, Ordovas K, Chun K, Chien JD, Schaeffer S, Wintermark M. Carotid atherosclerosis does not predict coronary, vertebral, or aortic atherosclerosis in patients with acute stroke symptoms. Stroke, 2010;41(8):1604-1609. DOI: 10.1161/Strokeaha.109.577437
• Dharmasaroja PA, Piyayotai D, Hutayanon P, Buakhamsri A, Intharakham K. Extracranial carotid stenosis and peripheral arterial disease in Thai patients with coronary artery disease. Angiology 2010;61(4):329-332. DOI: 10.1177/0003319709356423
• Järvisalo MJ, Jartti L, Näntö-Salonen K, Irjala K, Rönnemaa T, Hartiala JJ, Celermajer DS, Raitakari OT. Increased aortic intima-media thickness:a marker of preclinical atherosclerosis in high-risk children. Circulation 2001;104:2943-2947. DOI: 10.1161/hc4901.100522
• Aboyans V, Kamineni A, Allison MA, McDermott MM, Crouse JR, Ni H, Szklo M, Criqui MH. The epidemiology of subclavian stenosis and its association with markers of subclinical atherosclerosis: The multi-ethnic study of atherosclerosis (MESA). Atherosclerosis 2010;211(1):266-270. DOI: 10.1016%2Fj.atherosclerosis.2010.01.013
• Przewłocki T, Kabłak-Ziembicka A, Kozanecki A, Musiałek P, Piskorz A, Rzeźnik D, Pieniazek P, Rubiś P, Tracz W. Supra-aortic extracranial artery atherosclerotic lesions in patients diagnosed for coronary artery disease: Prevalence and predictors. Kardiol Pol. 2009;67(8A):985-991.
• Botta L, Sonker U, Heijmen RH. Diffuse atherosclerosis of thoracic aorta involving supraaortic and coronary arteries: Single-stage surgical revascularization. Thorac Cardiovasc Surg. 2008;5(8):490-492. DOI: 10.1055/s-2007-965712
• Engelhorn CA, Engelhorn AL, Cassou MF, Zanoni CC, Gosalan CJ, Ribas E, Pacholok A, Koehler Mde F. Intima-media thickness in the origin of right subclavian artery as an early marker of cardiovascular risk. Arq Bras Cardiol. 2006;87(5):609-614. DOI: 10.1590/S0066-782X2006001800010
• Gongora-Rivera F, Labreuche J, Jaramillo A, Steg PG, Hauw JJ, Amarenco P. Autopsy prevalence of coronary atherosclerosis in patients with fatal stroke. Stroke 2007;38:1203–1210. DOI: 10.1161/01.STR.0000260091.13729.96
• Polak F, Tracy R, Harrington A, Zavodni AEH, H.O'Leary MDH. Carotid artery plaque and progression of coronary artery calcium: The multi-ethnic study of atherosclerosis. Journal of the American Society of Echocardiography 2013;26(5):548-555. DOI: 10.1016/j.echo.2013.02.009
• Puz P, Lasek-Bal A, Warsz-Wianecka A, Kaźmierski M. Prevalence of atherosclerotic stenosis of the carotid and cerebral arteries in patients with stable or unstable coronary artery disease. PAIM2020;130(5):412-419.DOI: 10.20452/pamw.15330
• Jashari F, Ibrahimi P, Nicoll R, Bajraktari G, Wester P, Henein MY. Coronary and carotid atherosclerosis: Similarities and differences. Atherosclerosis, 2013;227(2):193-200. DOI: 10.1016/j.atherosclerosis.2012.11.008
• Poredos1 P, Jezovnik MK. Preclinical carotid atherosclerosis as an indicator of polyvascular disease: A narrative review. Ann Transl Med 2021;9(14):1204-1214. DOI: 10.21037/atm-20-5570
• Svanteson M, Rollefstad S, Klow NE, Hisdal J, Ikdahl E, Semb AG, Haig Y. Associations between coronary and carotid artery atherosclerosis in patients with inflammatory joint diseases. RMD Open 2017;3:1-8 e000544. DOI:10.1136/rmdopen-2017-000544
• Gallino A, Aboyans V, Diehm C, Cosentino F, Stricker H, Falk E, Schouten O, Lekakis J, Amann-Vesti B, Siclari F, Poredos P, Novo S, Brodmann M,Schulte KL, Vlachopoulos C, Caterina RD, Libby P, Baumgartner. Non-coronary atherosclerosis. European Heart Journal 2014;35:1112–1119 DOI:10.1093/eurheartj/ehu071
• Ozkara E, Yemiscigil A. A search of medicolegal autopsies for atherosclerosis. Türkiye Ekopatoloji Dergisi, 2000;6(3-4):181-183.
• Murray ET, Diez Roux AV, Carnethon M, Lutsey PL, Ni H, O'Meara ES. Trajectories of neighborhood poverty and associations with subclinical atherosclerosis and associated risk factors: the multi-ethnic study of atherosclerosis. Am J Epidemiol 2010;15;171(10):1099-1108. DOI: 10.1093/aje/kwq044
• Pedersen HS, Mulvad G, Newman WP 3rd, Boudreau DA. Atherosclerosis in coronary arteries and aorta among Greenlanders: An autopsy study. Atherosclerosis. 2003;170(1):93-103. DOI: 10.1016/s0021-9150(03)00240-5
• Kitulwatte ID, Sven PM. A Comparative study of coronary atherosclerosis in young and old. Am J Forensic Med Pathol 2015;36 (4):323-326. DOI: 10.1097/PAF.0000000000000203
• Jia EZ, Liang J, Yang ZJ, Zhu TB, Wang LS, Chen B, Cao KJ, Huang J, Ma WZ. Smoking and coronary atherosclerosis: Follow-up study in China. Clin Exp Pharmacol Physiol. 2009;36(7):690-695.DOI: 10.1111/j.1440-1681.2008.05134.x
• Nakashima Y, Kiyohara Y, Doi Y, Kubo M, Iida M, Sueishi K. Risk factors for coronary atherosclerosis in a general Japanese population: The Hisayama study. Pathol Res Pract. 2009;205(10):700-708. DOI: 10.1016/j.prp.2009.05.002
• Elsharawy MA, Alkhadra AH, Fakhary Abdulmohsen M, Bahnassy A. Impact of atherosclerotic risk factors on the extent of arterial occlusive disease among Arabian patients: a hospital based study. Int Angiol. 2009;28(5):367-372.