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By M. Brizzio

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This patient is a forty-three year old male. He died suddenly. Postmortem examination revealed disruption of the plaque and occlusive thrombus in the left anterior descending artery (Figure 3). Thrombus is composed of platelet thrombus and mixed thrombus + fibrin-rich thrombus (Figure 4 and 5). Platelet thrombus was adhered on the inner side of mixed thrombus + fibrin-rich thrombus (Figure 4). Immunohistochemistry for CD 42b revealed that platelet thrombus was deeply stained than mixed thrombus + fibrin-rich thrombus (Figure 4).

The pathogenesis of coronary artery disease and the acute coronary syndromes. N Engl J Med 1992;326:242-50. [35] Ross R. Atherosclerosis -an inflammatory disease. New Engl J Med 1999;340:115-26. [36] Kuller LH, Tracy RP, Shaten J, Meilahn EN. Relationship of C-reactive protein and coronary heart disease in the MRFIT nested case-control study : Multiple Risk Factor Intervention Trial. Am J Epidemiol 1996;144:537-47. [37] Koenig W, Sund M, Frohlich M. et al. C-rfeactive protein, a sensitive marker of inflammation, predicts future risk of coronary heart disease in initially healthy middle-aged men : results from the MONICA(monitoring Trends and Determinants in Cardiovascular Disease) Augsberg Cohort Study, 1984 to 1992.

Platelet thrombus was considered to repeat formation and disintegration with the gradual growth and lysis of RMT, and numerous emboli of fragments of platelet thrombus at the distal portion of the infarct related artery may repeatedly injure cardiac myocytes . 12. SRA index and vulnerable plaque Disruption, fissure, or erosion of an atherosclerotic plaque, with RMT has a fundamental role in the pathogenesis of acute coronary syndromes (ACS) 8-12. In general, in case of AMI, a direct relationship between the onset of plaque disruption and acute transmural ischemia is assumed; however pathological studies of autopsy 13, 14 and thrombectomy 18, 31, 43 materials indicated that plaque disruption, fissure or erosion with RMT remain clinically silent days or weeks before the fatal event.

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