Development and assessment of a histopathological stability score for atheroma plaques

Background: Vulnerable atherosclerotic plaques are central to the onset of acute coronary events and abrupt cardiac fatalities. Although significant strides have been made in understanding cardiovascular (CV) diseases, the field continues to require reliable, quantifiable approaches to assess plaque instability. Objective: The purpose of this study was to develop and confirm a novel tissue-based scoring system for evaluating the stability of atherosclerotic plaques, based on an in-depth examination of cases involving sudden cardiac death (SCD). Materials and Methods: We conducted a retrospective analysis of coronary artery specimens from 1189 instances of SCD, which were autopsied at the Institute of Forensic Medicine, Cluj-Napoca, Romania, from 2014 to 2018. The microscopic evaluation focused on key markers of plaque vulnerability, including the thickness of the fibrous cap, the extent of the necrotic core, the degree of inflammatory activity, the presence of bleeding within the plaque, and the nature of calcified deposits. These features were scored separately and integrated into an overall vulnerability metric. The score’s consistency and accuracy were tested against expert path