Sudden cardiac death and coronary disease in the young: A nationwide cohort study in Denmark

• Published in: International journal of cardiology Vol. 236; pp. 16 - 22
• Main Authors: Zachariasardóttir, Sára, Risgaard, Bjarke, Ågesen, Frederik Nybye, Jabbari, Reza, Glinge, Charlotte, Ingemann-Hansen, Ole, Ottesen, Gyda Lolk, Thomsen, Jørgen Lange, Haunsø, Stig, Banner, Jytte, Winkel, Bo Gregers, Tfelt-Hansen, Jacob
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01-06-2017
• Subjects: Adult; Age Factors; Arrhythmias, Cardiac - complications; Arrhythmias, Cardiac - diagnosis; Arrhythmias, Cardiac - mortality; Autopsy; Autopsy - statistics & numerical data; Cardiovascular; Cause of Death; Coronary artery disease; Coronary Artery Disease - complications; Coronary Artery Disease - diagnosis; Coronary Artery Disease - mortality; Coronary Vessels - pathology; Death Certificates; Death, Sudden, Cardiac - epidemiology; Death, Sudden, Cardiac - etiology; Death, Sudden, Cardiac - pathology; Denmark - epidemiology; Disease Progression; Epidemiology; Female; Humans; Male; Medical Records - statistics & numerical data; Middle Aged; Pathology; Severity of Illness Index; Sudden cardiac death; Young Adult; Young people; Young people; Pathology; Sudden cardiac death; Autopsy; Coronary artery disease; Epidemiology
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2017.01.118

Abstract Background Sudden cardiac death caused by coronary artery disease (CAD-SCD) is the most frequent cause of SCD in persons < 50 years. The aim of this study was to examine differences in clinical characteristics and autopsy findings of the heart among 18–35 and 36–49 year old CAD-SCD cases. Methods We have previously identified all sudden cardiac deaths in Denmark through review of death certificates and autopsy reports including all deaths between 2000 and 2006 in individuals aged 18–35 years and all deaths between 2007 and 2009 in individuals aged 18–49 years. In this study we included the 197 autopsied CAD-SCD cases. Full autopsy report and medical records from general practitioners and hospitals were obtained. Results There was a male predominance ( n = 151, 76%) and the median age was 42 years. In witnessed cases, 51% had a shockable rhythm and 9 cases returned to spontaneous circulation briefly, CAD-SCD victims aged 36–49 years had more severe atherosclerosis in all coronary arteries, more multi-vessel disease (29% vs. 15%, p = 0.049) and less commonly (38% vs. 54%, p = 0.039) acute coronary occlusion than victims < 36 years. Sixty-eight percent( n = 133) of CAD-SCD victims had cardiac symptoms prior to death. Conclusion This nationwide study found several differences in the pathologic lesions of the heart in victims aged 18–35 and 36–49 years, which might be associated with different disease progression leading to death in these age groups. We also report a high frequency of cardiac symptoms prior to death in young CAD-SCD cases, which may enable clinicians to prevent these tragic deaths.