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

Abstract

Background: Sudden cardiac death caused by coronary artery disease (CAD-SCD) is the most frequent cause of SCD in persons <50years. The aim of this study was to examine differences in clinical characteristics and autopsy findings of the heart among 18-35 and 36-49year 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 18-35years and all deaths between 2007 and 2009 in individuals aged 18-49years. 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 42years. In witnessed cases, 51% had a shockable rhythm and 9 cases returned to spontaneous circulation briefly, CAD-SCD victims aged 36-49years 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 <36years. 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 36-49years, 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.

Keywords: Autopsy; Coronary artery disease; Epidemiology; Pathology; Sudden cardiac death; Young people.