Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
JCR Impact Factor (IF) – 2.1
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ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
Periodicity – monthly

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Advances in Clinical and Experimental Medicine

2018, vol. 27, nr 1, January, p. 63–70

doi: 10.17219/acem/65866

Publication type: original article

Language: English

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Heart infarct as the major cause of death of hematological patients as identified by autopsy

Anna Waszczuk-Gajda1,B,C,D,E,F, Michał F. Kamiński1,2,B,C,D, Łukasz Koperski3,E, Anna Kamińska1,4,B,C, Joanna Drozd-Sokołowska1,B,C, Zbigniew Lewandowski5,C, Aleksander Wasiutyński6,F, Barbara Górnicka3,F, Wiesław W. Jędrzejczak1,A,E,F

1 Department of Hematology, Oncology and Internal Diseases, Medical University of Warsaw, Poland

2 Department of Gastroenterology, Hepatology and Oncology, Medical Centre for Postgraduate Education, The Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warszawa, Poland

3 Department of Pathology, Medical University of Warsaw, Poland

4 II Department of Obstetrics and Gynecology, Medical University of Warsaw, Poland

5 Department of Epidemiology and Biostatistics, Medical University of Warsaw, Poland

6 Department of Pathomorphology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warszawa, Poland

Abstract

Background. Despite progress in diagnostic procedures, clinical diagnosis is not always confirmed by an autopsy. An autopsy is a valuable tool in evaluating diagnostic accuracy.
Objectives. The aim of the study was to compare clinical diagnoses of immediate causes of death with autopsy findings in patients with hematological malignancies or aplastic anemia.
Material and Methods. In this study, the results of 154 autopsies (1993–2004) of patients with hematological diseases were reviewed and compared with clinical data. The most probable causes of death in the case of particular hematological diseases as well as the discordances between clinical and autopsy diagnoses and their relation to the clinical characteristic were identified in the studied cohort, which primarily included patients whose death at that particular time was not explained by the clinical course, and in 50% of cases was sudden.
Results. Although various combined infections have been found to be responsible for the largest number of deaths (26.6%), the most common single cause was myocardial infarction (29 patients, 18.8%). The discordance between clinical and post-mortem diagnoses of immediate causes of death was found in 55 patients (35.7%; 95% CI 28.2–42.8%), with 50.9% of cases considered class I discrepancies according to Goldman’s criteria. The myocardial infarction was found to be clinically undiagnosed in 69% of cases. In 41% of cases, it was a class I discrepant diagnosis.
Conclusion. This data suggests that hematological patients require special attention and probably preventive measures concerning coronary heart disease, particularly during the initiation of antineoplastic therapy.

Key words

hematology, malignancies, cause of death, discordance, autopsy

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