A 58-year-old man receives primary percutaneous intervention for an acute STEMI. He dies of cardiogenic shock two days later despite a patent stented vessel. Histology of the reperfused infarct zone shows squiggly bands of densely eosinophilic, hypercontracted sarcomeres within necrotic myocytes. This finding indicates:

• A Granulation tissue organisation of the infarct
• B Coagulative necrosis from permanent occlusion
• C Myocardial stunning
• D Reperfusion injury ✓

Explanation

Contraction band necrosis arises when calcium floods lethally injured cells at the moment blood flow is restored, producing hypercontraction of myofibrils; it is the hallmark of reperfusion injury. Coagulative necrosis from unreperfused infarction shows wavy fibres, then coagulative change without these dense eosinophilic cross-bands. Stunning denotes transient post-ischaemic dysfunction with viable myocytes and would not show this lesion.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

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Written and medically reviewed by the StethoPrep medical team.