Diagnosis of myocardial infarction at autopsy: AECVP reappraisal in the light of the current clinical classification

• Published in: Virchows Archiv : an international journal of pathology Vol. 476; no. 2; pp. 179 - 194
• Main Authors: Michaud, Katarzyna, Basso, Cristina, d’Amati, Giulia, Giordano, Carla, Kholová, Ivana, Preston, Stephen D., Rizzo, Stefania, Sabatasso, Sara, Sheppard, Mary N., Vink, Aryan, van der Wal, Allard C.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.02.2020; Springer Nature B.V
• Subjects: Acute coronary syndromes; Autopsies; Autopsy; Autopsy - methods; Cardiovascular diseases; Coronary artery disease; Death, Sudden, Cardiac - pathology; Diagnosis; Diagnostic systems; Electrocardiography; Forensic Pathology - methods; Forensic science; Heart attacks; Heart diseases; Humans; Ischemia; Medical diagnosis; Medicine; Medicine & Public Health; Morbidity; Myocardial infarction; Myocardial Infarction - diagnosis; Myocardial Infarction - pathology; Myocardium - pathology; Occlusion; Pathology; Pathology, Clinical - methods; Review and Perspectives; Review and s; Myocardial infarction; Immunohistochemistry; Acute coronary syndromes; Autopsy; Post-mortem imaging; Myocardial injury
• ISSN: 0945-6317; 1432-2307; 1432-2307
• DOI: 10.1007/s00428-019-02662-1

Ischemic heart disease is one of the leading causes of morbidity and death worldwide. Consequently, myocardial infarctions are often encountered in clinical and forensic autopsies, and diagnosis can be challenging, especially in the absence of an acute coronary occlusion. Precise histopathological identification and timing of myocardial infarction in humans often remains uncertain while it can be of crucial importance, especially in a forensic setting when third person involvement or medical responsibilities are in question. A proper post-mortem diagnosis requires not only up-to-date knowledge of the ischemic coronary and myocardial pathology, but also a correct interpretation of such findings in relation to the clinical scenario of the deceased. For these reasons, it is important for pathologists to be familiar with the different clinically defined types of myocardial infarction and to discriminate myocardial infarction from other forms of myocardial injury. This article reviews present knowledge and post-mortem diagnostic methods, including post-mortem imaging, to reveal the different types of myocardial injury and the clinical-pathological correlations with currently defined types of myocardial infarction.