Pathology of fatal acute myocardial infarction in the Chinese.

Post-mortem examinations were performed on 89 Chinese with fatal acute myocardial infarction, who represented an unselected 45.6% of a series comprising 195 consecutive hospital deaths from acute myocardial infarction in Hong Kong. In 83 patients (93.3%), the acute infarcts were correctly identified, and old infarct scars or patchy fibrosis were found in 21 patients (23.6%). Of the 85 sudden deaths, 33 patients (38.8%) had no definite mechanical complication and therefore could have died of primary arrhythmias, ten patients (11.8%) had rupture in the free ventricular wall with cardiac tamponade. Two other patients had rupture of the interventricular septum and one more patient had rupture of papillary muscle. Evidence of significant coronary atherosclerosis was identified in 94.7% of patients, with one-vessel disease in 18.7%, two-vessel disease in 33.3% and three-vessel disease in 42.7% of patients respectively. Critical lesions were present in left main stem in 8%, left anterior descending artery in 45.3%, circumflex artery in 8% and right coronary artery in 17.3% respectively. Occlusive coronary thrombi were identified in 18.7% of patients. These pathological findings were compared with reports on fatal myocardial infarctions from the western countries.