Histological classification of atherosclerosis and correlation with ischemic heart disease: A autopsy based study

Background: There is an ever increasing trend of rise of coronary artery disease (CAD) in India and globally. The grading of coronary atherosclerotic lesions is important as it correlates with significant cardiac lesions like acute myocardial infarction (MI), myocardial fibrosis and left ventricular hypertrophy (LVH) etc. To study the same in living subjects is difficult, hence autopsy studies are done. Our 1 year retrospective study aims at grading the coronary atherosclerotic lesions and correlating the results with simulating studies in India and abroad. Method: The present study was conducted in  the Department of Pathology, JLN Medical College, Ajmer (Rajasthan). Duration of study was from January 2011 to December 2011. Total 103 post-mortem heart specimens, irrespective of cause of death were examined grossly and microscopically for extent of coronary artherosclerosis and associated cardiac lesions. Results: Of the 103, males affected was 74.75% and females was 25.24%. Commonest type of atherosclerosis was type III (preatheroma) 40.7%. 55.33% showed significant coronary artery disease (type IV -VIII) with atheroma (type IV) as the commonest lesion (23.30%). Left anterior descending artery (LADA) was most frequently involved vessels (46.6%) followed by right coronary artery (RCA) involvement (41.71%). Least frequently involved vessel was left circumflex artery (LCX) (38.83%). 15% had single vessel involvement whereas 37% & 40% cases had two vessels and three vessels  involvement  respectively. Conclusion:  Maximum cases of significant cardiac lesions were associated with  advanced atherosclerotic lesions ie. type VI & type VII  lesions. Eccentric lesions were more common than concentric lesions.