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

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 andmedical 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. (C) 2017 Elsevier B.V. All rights reserved.