An Autopsy Study of 36 Cases of Cardiopulmonary Arrest on Arrival with Acute Myocardial Infarction

Acute myocardial infarction (AMI) is one of the most serious causes of cardiopulmonary arrest on arrival (CPAOA). We performed postmortem examination in 73 CPAOA cases with unknown clinical diagnosis to investigate the direct cause of death, and found 36 cases to have developed AMI. Pathological finding in left main trunk (LMT) was noted in 3 cases (8.2%) and it was also noted in left anterior descending artery (LAD), in left circumflex artery (LCx), and in right coronary artery (RCA) in 11 cases (10.6%). The most frequent finding was single vessel disease (15 cases, 41.7%) followed by triple vessel disease (13 cases, 36.1%). Acute heart failure death was noted in 19 cases (52.8%) and second-time infarction in 63.2% of cases. Death due to fatal arrhythmia was determined in 10 cases (27.8%), and cardiac rupture in 7 cases (19.4%). The latter occurred more often in first-time infarction (85.7%). Fatal cardiac rupture was significantly associated with LAD infarction (71% of cases, p<0.05), while fatal arrhythmia was significantly associated with RCA infarction (60% of cases, p<0.05). Single vessel disease, especially the disease in LAD or RCA might be the high risk factor of CPA in AMI patients.