THE RELATION BETWEEN MYOCARDIAL LESIONS AND CORONARY ARTERY DISEASE II. A SELECTED GROUP OF PATIENTS WITH MASSIVE CARDIAC NECROSIS OR SCARRING

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Abstract
Seventy-nine patients (57 men and 22 women) with large cardiac lesions consisting of necrosis or scarring were studied and compared with an unselected necropsy sample examined in the same way. Large lesions showed a strong association with coronary occlusion and can be accurately described as myocardial infarcts. The age and number of the large lesions is related to the occlusion frequency and the type of occluding mass. The significance of this is discussed, with particular reference to the severe coronary narrowing associated with large lesions. Of the other cardiac lesions defined in the random survey, two types showed a strong association with large lesions[long dash]massive endocardial fibrosis and one type of papillary fibrosis. Small replacement lesions, perivascular and interstitial fibrosis, and the papillary fibrosis associated with small vessel thickening were no more common in patients with large lesions than in the random sample. The histological appearance of the so-called "subendocardial plexus" is described, and the relation of this mesh of vessels to healing large lesions is emphasized. The prevalence of coronary calcification and intercoronary anastomoses is compared with the random sample, and an association between increased heart weight and the age and number of large lesions is described.