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Background and aims:Atherosclerosis is a systemic disorder that develops in any blood vessel of the body. Atherosclerosis can result in fatal complications such as myocardial infarction or stroke. The aim of this study was to compare the severity of atherosclerosis between the coronary arteries and other peripheral arteries. To our knowledge, no such morphometric tissue studies through autopsy samples so far are available in Korea. Methods: The left anterior descending artery, right coronary artery and bilateral carotid, renal and femoral arteries were obtained from 50 autopsies during the period from June to October 2008. Detailed gross examination of the each arteries was performed to look for the most severe site of luminal narrowing. Results: There was a significant correlation between the maximal carotid artery intima-media thickness and the largest plaque area of the coronary artery (P < 0.05). However, some discordant cases were also noted. Seven cases had more severe coronary atherosclerosis compared to the carotid artery. Conclusions:The careful examination of peripheral arteries including the carotid artery can be helpful in clinical prediction of coronary artery disease. However, such prediction should include other risk factors such as age, hypertension, diabetes and dyslipidemia and other relevant clinical conditions.

Medico-legal investigations in Korea depend mostly on postmortem inspection without autopsy. Both untrained physicians and experienced forensic pathologists may not be able to determine the cause and manner of death only by postmortem inspection. The aim of our study was to show the limitations of postmortem inspection by evaluating the discrepancy between the results of postmortem inspection and autopsy after natural death. The manner of death by postmortem inspection changed to unnatural death in 9.4% of the cases (12 cases/127 cases) after autopsy. The cause of death in most cases was consumption of alcohol, agricultural chemicals, and antipsychotic intoxication. The cause of death by postmortem inspection changed in 24.3% of the cases (26 cases/107 cases) among cases of confirmed natural death after autopsy. The positive predictive value of cause of death by postmortem inspection was higher for cardiovascular disease (79.0%) and lower for chronic alcoholism and/or chronic liver disease (28.6%). This study shows that forensic pathologists could make considerable errors in determining the cause and manner of death without autopsy and emphasizes the necessity to refine medico-legal investigations in Korea by introducing the limited autopsy with toxicologic study and supportive postmortem imaging.

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