A Clinicopathologic Study of Outpatients Dying at a Critical Care Medical Center.

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  • 救命救急センター外来死亡症例の臨床病理学的検討

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Abstract

We clarified the cause of death in 108 of 1437 patients examined for cardiopulmonary arrest (CPA) or neardeath based on autopsies in the last 8 years at our critical care medical center. Of the 108, 69 (64%) were classified with cardiac disease and 65 diagnosed clinopathologically as sudden cardiac death (SCD), i.e., death due to cardiac disease within 24 hours of symptom onset. Causes of SCD were classified into, (1) acute myocardial infarction (AMI) (28%) and (2) all other disorders (72%). Of these without AMI, 40 (85%) had a specific clinicopathological cardiac disorder, as indicated by greater myocardial fiber eosinophilic staining compared to normal fibers with hematoxylin-eosin (HE) staining. This finding was diffuse in the myocardium of both ventricles. Eosinophilic fibers were negative or only weakly positive to myoglobin immunohistochemical staining using antimyoglobin antibody. Most of the cases showed no coronary obstruction or severe narrowing. Clinically, this specific cardiac disorder occurs frequently than AMI in men at a ratio of 4:1 vs. women and in younger patients. Of the 40 with this specific disorder, 28 died within 30 minutes of symptom onset and 12 within 30 minutes to 24 hours. We suspect that acute myocardial ischemia induced by coronary vasospasm may have caused the myocardial eosinophilic change in these cases. We propose calling this specific clinicopathological cardiac disorder “superacute myocardial eosinophilic change (SMEC)”.

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