Sudden coronary death caused by pathologic intimal thickening without atheromatous plaque formation

Fabio Tavora, Nathaniel Cresswell, Ling Li, Mary Ripple, David Fowler, Allen Burke

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


Background: Atherosclerotic plaques progress from early lesions with little free cholesterol and lipid to late fibroatheromas with necrotic cores that may rupture. The frequency of severe coronary atherosclerosis without core formation in any artery in sudden coronary death is not known. Methods: We studied 314 hearts from 253 men and 61 women who died suddenly from severe coronary stenosis (≥1 epicardial artery with ≥75% luminal area narrowing) and with no other cause of death. If no section demonstrated any necrotic core, the designation was nonatheromatous atherosclerosis; if there was ≥1 necrotic core, the designation was atheromatous atherosclerosis. Plaques were scored for the presence of calcification, intimal inflammation, and neovasculature on a 5-point scale. Plaque burden was estimated semiquantitatively. Results: In 22 men (9%) and 14 women (23%), there were no necrotic cores in any plaque (nonatheromatous atherosclerosis). Fourteen of these 36 nonatheromatous atherosclerosis cases had focal acute thrombus due to erosion (39%). Of the remaining 278 cases (atheromatous atherosclerosis), acute erosions were present in 25 (9%; P10% of sudden coronary deaths and is more frequent in young Black women. Nonatheromatous atherosclerosis is a relatively infrequent pathway for coronary plaque progression, leading to severe disease and sudden death that may involve plaque erosion.

Original languageEnglish (US)
Pages (from-to)51-57
Number of pages7
JournalCardiovascular Pathology
Issue number1
StatePublished - Jan 2011
Externally publishedYes


  • Atheroma
  • Coronary plaque
  • Pathologic intimal thickening
  • Sudden coronary death

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pathology and Forensic Medicine


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