Discrepancies Between Cineangiographic and Postmortem Findings in Patients with Coronary Artery Disease and Recent Myocardial Revascularization

Abstract

In 28 consecutive patients who died following coronary artery grafting and within 30 days of a previous coronary cineangiogram, a study was undertaken to compare the findings at autopsy and those at angiography. In five instances, such a comparison could not be made: in one instance, no postmortem examination was obtained, and in four additional cases, the quality of the cineangiographic document (three instances) or the pathological specimen (one instance) did not permit a reliable comparison. In the remaining 23 cases, there were nine specimens in which an appreciable difference (≥ 25%) was noted in the severity of the coronary artery lesions. In four of these nine cases, failure of cineangiography to assess the degree of coronary arterial narrowing led to incomplete myocardial revascularization and contributed, in retrospect, to the surgical failure. Most discrepancies occurred in the left coronary artery system, despite the fact that in all instances, four projections had been obtained of the left coronary artery in the transverse plane. Because of the particular orientation of the initial portion of the left coronary artery and its major divisions, it is recommended that additional projections in the sagittal plane be included to eliminate angiographic superimposition of multiple branches, which often cannot be properly separated in the standard transverse plane.