Post-mortem studies
Several retrospective autopsy (post-mortem) series have been reported. These do not include SCDs where a general practitioner (GP) certified (without a post-mortem) a patient with known CHD who died suddenly as having died, for example, of a ‘myocardial infarct’. This is usually done with the knowledge of the coroner.
The Report of the Task Force on Sudden Cardiac Death Chapter 2
In one series in the UK, 692 SCD autopsy results were analysed for white Caucasians between 16 and 64 years of age with no history of cardiac disease. Eighty-two per cent of deaths were due to CHD and 12% had other cardiac pathology. Of the remainder, 2% had a history of some other condition but in 4% no cause of death could be identified. The annual rate of SCD (including unidentified causes) in this population was 11 per 100,000.
A study in Belfast identified SCDs from EMS and autopsy reports. There were autopsy reports for 37% of cases.8 In the autopsy group, 60% had no known history of cardiac disease but severe coronary artery disease was found in 94%.
Nearly 2,000 reports were analysed of post-mortems at Connolly Hospital, Dublin between January 1987 and December 2001.9 Of these, 777 (69% male, 31% female) were performed because of sudden, unexpected, out-of-hospital death occurring within 1 hour of symptom onset. The underlying cause of death was cardiac in 608 subjects (78%). In these, a possible mechanical cause of death was found in 28%, therefore an arrhythmia was the presumed mechanism of death in 72%.
There has been particular interest in the findings at post-mortem of SCD in young people. In a retrospective series looking at 72 SCDs under 35 years of age in Dublin between 1993 and 2002, death was most frequently attributed to CHD, followed by hypertrophic cardiomyopathy (HCM) (24% of deaths). Patients with congenital heart disease and those younger than 10 years of age were excluded from this study.
Between 1992 and 1999 the Swedish national database of forensic medicine recorded 181 cases of SCD in the 15 to 35 year age group, 73% male and 27% female.11 The incidence rate of 0.93 / 100,000 was stable over time. A cardiomyopathy was found in 23%, CHD in 18% and myocarditis in 11%. No structural cardiac abnormality was found in 21%.
An autopsy series of 193 cases of SCD aged 35 or younger in Sydney, Australia between 1994 and 2002 found CHD in 24%, cardiomyopathy in 15% and myocarditis in 12%. No structural abnormality was found in 31% and death was presumed to be due to a disorder leading to a fatal cardiac arrhythmia. Approximately 5% of SCDs are unexplained, and no structural abnormality is found at postmortem.
The proportion rises to 20 – 30% in those under the age of 35 years. The percentage in whom no structural abnormality is found is higher in young women than in young men, 50% compared to 24% in one series of cases in the 35 to 44 year age group in the US.14 In the 28% of cases in whom no structural abnormality was found in an Italian series of cases aged 35 or younger, two-thirds were men and one-third women. A genetic factor can be identified in only a small proportion of cases at present but it is expected that this will increase with the identification of further gene defects.
The Royal College of Pathologists has published guidelines on autopsy practice in sudden
death with likely cardiac pathology.16 The contribution of specialist cardiac pathologists to
the surveillance of SCD in Ireland is discussed in Section 6.2 of this report.
The Report of the Task Force on Sudden Cardiac Death Chapter 2
In one series in the UK, 692 SCD autopsy results were analysed for white Caucasians between 16 and 64 years of age with no history of cardiac disease. Eighty-two per cent of deaths were due to CHD and 12% had other cardiac pathology. Of the remainder, 2% had a history of some other condition but in 4% no cause of death could be identified. The annual rate of SCD (including unidentified causes) in this population was 11 per 100,000.
A study in Belfast identified SCDs from EMS and autopsy reports. There were autopsy reports for 37% of cases.8 In the autopsy group, 60% had no known history of cardiac disease but severe coronary artery disease was found in 94%.
Nearly 2,000 reports were analysed of post-mortems at Connolly Hospital, Dublin between January 1987 and December 2001.9 Of these, 777 (69% male, 31% female) were performed because of sudden, unexpected, out-of-hospital death occurring within 1 hour of symptom onset. The underlying cause of death was cardiac in 608 subjects (78%). In these, a possible mechanical cause of death was found in 28%, therefore an arrhythmia was the presumed mechanism of death in 72%.
There has been particular interest in the findings at post-mortem of SCD in young people. In a retrospective series looking at 72 SCDs under 35 years of age in Dublin between 1993 and 2002, death was most frequently attributed to CHD, followed by hypertrophic cardiomyopathy (HCM) (24% of deaths). Patients with congenital heart disease and those younger than 10 years of age were excluded from this study.
Between 1992 and 1999 the Swedish national database of forensic medicine recorded 181 cases of SCD in the 15 to 35 year age group, 73% male and 27% female.11 The incidence rate of 0.93 / 100,000 was stable over time. A cardiomyopathy was found in 23%, CHD in 18% and myocarditis in 11%. No structural cardiac abnormality was found in 21%.
An autopsy series of 193 cases of SCD aged 35 or younger in Sydney, Australia between 1994 and 2002 found CHD in 24%, cardiomyopathy in 15% and myocarditis in 12%. No structural abnormality was found in 31% and death was presumed to be due to a disorder leading to a fatal cardiac arrhythmia. Approximately 5% of SCDs are unexplained, and no structural abnormality is found at postmortem.
The proportion rises to 20 – 30% in those under the age of 35 years. The percentage in whom no structural abnormality is found is higher in young women than in young men, 50% compared to 24% in one series of cases in the 35 to 44 year age group in the US.14 In the 28% of cases in whom no structural abnormality was found in an Italian series of cases aged 35 or younger, two-thirds were men and one-third women. A genetic factor can be identified in only a small proportion of cases at present but it is expected that this will increase with the identification of further gene defects.
The Royal College of Pathologists has published guidelines on autopsy practice in sudden
death with likely cardiac pathology.16 The contribution of specialist cardiac pathologists to
the surveillance of SCD in Ireland is discussed in Section 6.2 of this report.
posted by AED Ireland at
11:37 AM
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