Forensic Pathological Study of 1656 Cases of Sudden Cardiac Death in Southern China

Abstract

Sudden cardiac death (SCD) is progressively threatening the lives of young people throughout the world. We conducted a retrospective study of SCD cases identified among sudden death cases based on comprehensive autopsies and pathological examinations in the Center for Medicolegal Expertise of Sun Yat-Sen University to investigate the exact etiological distribution and epidemiological features of SCD. One thousand six hundred fifty-six cases were identified, and SCD accounted for 43.0% of these sudden death cases. The mean age of the SCD cases-where the data of definite ages were accessible-was 38.2 years, and the highest incidence occurred among the 31- to 40-year-old cases (25.6%). The male-to-female ratio among SCD cases was 4.3:1, and this ratio peaked in the 41- to 50-year-old group (7.7:1). The places of death were confirmed in 1411 cases, and predominantly in hospitals (46.3%) and at home (33.8%). SCD occurred throughout the year with a marginally increase in April and May. The major causes of SCD were coronary atherosclerotic disease (CAD, 41.6%), unexplained sudden death (15.1%), and myocarditis (11.8%). Our data indicated that in the age group of younger affected persons (below 35 years old), sudden unexplained death and myocarditis were much more prevalent than CAD. According to anatomical examinations of the CAD-related SCD cases, the proportion of cases with coronary artery stenosis exceeding 75% (grade IV) was 67.2%. Moreover, the percentages of higher grades of coronary atherosclerosis increased with age. Among all branches of the coronary arteries, the left anterior descending branch was the most prone to atherosclerosis; atherosclerosis was present in this branch in 95.4% of the cases with atherosclerosis. Additionally, lesions of multiple branches of the coronary artery were associated with ageing. This is the first study to report the causes of death and basic epidemiological data related to SCD in Southern China.

FIGURE 1

The distribution of age and gender in sudden cardiac death cases. Sudden cardiac death (SCD) cases occurred more frequently in males than females in all age groups. And both male and female SCD victims were most among the age groups of 21 to 30, 31 to 40, and 41 to 50 years old.

FIGURE 2

The monthly distribution of sudden cardiac death cases. Sudden cardiac death was the most prevalent in the months of April, May, June, and July, and the least prevalent in January and February.

FIGURE 3

Forensic pathological diagnoses of 1656 SCD cases presented as percentages. Coronary atherosclerotic heart disease, sudden unexplained death, and viral myocarditis were the 3 leading causes of SCD accounting for 41.61%, 15.16%, and 11.84% of the cases, respectively.

FIGURE 4

The etiological distributions of sudden cardiac death in the different age groups. Coronary atherosclerotic heart disease was the leading cause death in the 35- to 55 and >55-year-old age groups, whereas sudden unexplained death, viral myocarditis, and coronary atherosclerotic heart disease were the leading causes in the <35-year-old group.

FIGURE 5

Frequencies (%) of coronary artery stenosis grades I–IV in the 3 age groups. The percentages of higher grades of coronary atherosclerosis increased with age.

FIGURE 6

Frequencies (%) of the numbers of coronary artery branches involved in CAD in the 3 age groups. Multiple-branches coronary artery lesions increased with age.