[Correct clinical diagnosis concerning cerebrovascular diseases and myocardial infarction among pathological autopsy cases in Japan]

Abstract

Autopsy cases reported in "Annual of the Pathological Autopsy Cases (Vol. 29, 1986-Vol. 33, 1990)" were analyzed to elucidate the percentage incidences of correct clinical diagnosis concerning cerebrovascular diseases and myocardial infarction. In 19,402 cases (aged 30 years and over), cerebral infarction, cerebral hemorrhage, subarachnoid hemorrhage and myocardial infarction were reported as major pathologic changes. The percentage of the correct clinical diagnosis was 88.4% of 2,858 cases with subarachnoid hemorrhage, 84.7% of 3,051 cases with cerebral hemorrhage and 80.3% of 3,602 cases with cerebral infarction. The clinical diagnosis was correct in 66.6% of 9,891 cases with myocardial infarction. The difference between incidence of cerebrovascular disease and myocardial infarction was statistically significant (p < .001). In women with subarachnoid hemorrhage, correct clinical diagnosis was made in 90.6% and the more than 85.5% in men (p < .0001). Among the older patients (aged 60 years and over) with cerebral infarction, 81.5% were diagnosed correctly while that in the middle-aged (aged 30-59 years) was 70.7% (p < .0001). The autopsy cases from general hospitals showed a somewhat higher percentage concerning cerebral infarction and cerebral hemorrhage than those from university hospitals (p < .05). From 1986 to 1990, the ratio of accurate clinical diagnosis concerning cerebrovascular diseases was maintained as high as in 1986. The ratio for myocardial infarction decreased from 70.7% in 1986 to 63.1% in 1990. It was concluded that much efforts are needed to establish correct clinical diagnoses of myocardial infarction in Japan.