Abstract 16156: Sudden Cardiac Death in Middle Age
Introduction: We have previously reported that sudden cardiac death in middle-aged subjects is more likely to occur without warning, and patients have fewer co-morbidities compared to older subjects. Since mechanisms may differ between the two groups, there is a significant need to perform detailed comparisons of cardiac structural abnormalities.
Methods: From an established, dedicated cardiac pathology database in the Eastern US, we compared 175 consecutive middle-aged SCD patients (35-59 years) to 175 older patients (>60 years; 2005-2010). Individual level, detailed clinical and autopsy data including cardiac and coronary gross and histopathology findings were compared.
Results: In both groups, there was a male majority (middle age 75.4% and older 72.6%; p=0.54). There were no significant differences in cardiovascular risk factors such as hypertension, diabetes mellitus and hyperlipidemia. The prevalence of significant coronary artery disease (CAD, >75% stenosis in any major coronary artery) in the absence of acute coronary thrombosis was lower in middle age (30.9% vs. 42.9%; p=0.02) and middle aged cases were also less likely to have chronic total occlusion (CTO) (18.9% vs. 32%, p<0.01) and healed MI (26.9% vs. 38.3%; p=0.02). Middle aged subjects had lower prevalence of calcified coronaries compared to older subjects (29.7% vs. 74.9%; p<0.01) and lower prevalence of calcification in lesions with acute plaque rupture (47.5% vs. 69%; p=0.07). Rates of acute coronary thrombosis were similar in the two groups (22.9% vs. 16.6%; p=0.14). However, middle aged cases had higher plaque erosion (8% vs. 1.1%; p<0.01) and lower rate of calcified nodules (0 vs. 2.3%; p=0.04). The prevalence of coronary plaque rupture was comparable (14.9% vs. 13.1%; p=0.64).
Conclusions: In this detailed contemporary postmortem cardiac pathology evaluation, we observed a significantly lower burden of CAD in the middle aged vs. older groups, and a large subset of middle aged patients did not have identifiable cardiac etiologies of SCD. These findings highlight the possibility of potentially distinct mechanisms of fatal ventricular arrhythmias in middle vs. older age.
Author Disclosures: S.G. Nair: None. H. Mori: None. K. Reinier: None. F. Kolodgie: None. R. Virmani: None. S.S. Chugh: Research Grant; Significant; NIH (NHLBI), R01HL126938 and R01HL122492.
- © 2016 by American Heart Association, Inc.