Abstract 12141: Temporal Trends in the Characteristics of Autopsy-Verified Victims of Sudden Cardiac Death Without a Known Prior Cardiac Disease
Introduction: Coronary artery disease (CAD) has been shown to be the underlying structural cardiac disease in ~80% of the victims of sudden cardiac death (SCD) in the western societies. Since the primary prevention strategies, public awareness of early symptoms of CAD, and secondary prophylaxis has changed during the past 1-2 decades, we studied the temporal trends in the etiology of unexpected SCD in the FinGesture study.
Methods: FinGesture (n=3,727) is a prospective study assessing the phenotype and genotype profiles of SCD in a consecutive series of victims of SCD in a defined geographical area of Northern Finland. Because of Finnish law (Act on the Inquest into the Cause of Death, 459/1973, 7th paragraph), virtually all unexpected SCDs of subjects without a known prior cardiac disease undergo medigo-legal autopsy. In this study we analyzed the characteristics of SCD victims and autopsy findings in three 5-year periods; 1998-2002, 2003-2007 and 2008-2012, respectively.
Results: Among victims of SCD as a first cardiac event, the proportion with CAD at autopsy decreased during the time period 2008-2012 compared to the 2 preceding 5 year periods: 74.0% in 1998-2002, 73.1% in 2003-2007 and 66.4% in 2008-2012 (p<0.001 between 1998-2002 and 2008-2012, and between 2003-2007 and 2008-2012). At the same time, the proportion with hypertensive heart disease without an autopsy evidence of CAD increased from 1.7% in 1998-2002, to 5.8% in 2003-2007, and 8.9% in 2008-2012 (p<0.001 for all). Similarly, myocardial fibrosis without any known etiology was 6.7% in the last 5-year period compared to two previous 5-year periods (3.7% and 4.0%) (p<0.001 between 1998-2002 and 2008-2012, and similarly between 2003-2007 and 2008-2012).
Conclusions: In conclusion, the proportion of SCDs attributable to CAD, in the absence of a prior history of heart disease, has been decreasing, while the proportion associated with hypertensive heart disease and idiopathic fibrosis is increasing between 1998 and 2012.
Author Disclosures: E.K. Hookana: None. M. Junttila: None. K.S. Kaikkonen: None. M. Kortelainen: None. R.J. Myerburg: None. H.V. Huikuri: None.
- © 2014 by American Heart Association, Inc.