Post-mortem diagnosis of acute myocardial infarction in patients with acute respiratory failure - demographic, etiologic and histological pulmonary analysis

Abstract

Introduction: Acute respiratory failure (ARF) is present in 5% of the patients with acute myocardial infarction (AMI) and is responsible for 20% to 30% of the mortality post-AMI. It is unclear the role of inflammation correlated with pulmonary edema (PE) as a cause of ARF post-AMI. Objectives: Describe the demographic, etiologic data and histological pulmonary findings in autopsies of patients dead due to ARF with non-diagnosis AMI during life between 1,990 and 2,008. Methods: This study considers 4,223 autopsies of patients who died of ARF without cause of death related during life. The diagnosis of AMI was performed in 218 (4.63%) patients, and were obtained: age, sex and major associated diseases. Pulmonary histopathology was categorized as: diffuse alveolar damage (DAD); pulmonary edema (PE); alveolar hemorrhage (AH);and lympho-plamacytic interstitial pneumonia (LPIP). Odds ratio of AMI developing specific histopathology was determined by logistic regression. Results: Were observed 147 men and mean age was 64 years. Pulmonary histopathology showed, in descending order: PE (72.9%), DAD, LPIP and HA. Bacterial bronchopneumonia was present in 11.9%, systemic arterial hypertension in 10.1%, dilated cardiomyopathy in 6.9%, pulmonary embolism in 6.0%, hypertrophic cardiomyopathy in 4.6%, chronic obstructive pulmonary disease in 3.7% and diabetes mellitus in 3.7% of patients. Multivariate analysis demonstrated significantly positive association of IAM with PE and with DAD. Conclusions: For the first time we demonstrated that in autopsies of patients with ARF as cause of death, the diagnosis of AMI was present in about 5%. We observed important inflammatory response in pulmonary histology as never suggested before