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A pathological study of sudden coronary death in China: report of 89 autopsy cases
Insights
Sudden Coronary Death (SCD) is the most common cause of unexpected death in China, often linked to severe coronary artery narrowing and atherosclerosis. Middle-aged men are most affected, frequently dying during sleep without apparent triggers.
Area of Science:
- Forensic Pathology
- Cardiovascular Pathology
- Sudden Unexpected Death
Background:
- Coronary heart disease (CHD) incidence is low in China, yet Sudden Coronary Death (SCD) is a significant cause of unexpected mortality.
- Understanding the pathological basis of SCD is crucial for public health and forensic investigations.
Purpose of the Study:
- To conduct a forensic pathological analysis of 89 Sudden Coronary Death (SCD) cases.
- To characterize the coronary artery (CA) and myocardial pathology associated with SCD.
- To identify demographic and clinical factors contributing to SCD in the studied population.
Main Methods:
- Retrospective analysis of 89 autopsy cases diagnosed with Sudden Coronary Death (SCD).
- Detailed examination of coronary arteries (CA) for atherosclerotic plaque severity, cross-sectional area (XSA) narrowing, thrombosis, and hemorrhage.
- Histopathological assessment of the myocardium for inflammation, fibrosis, and infarction.
Main Results:
- Significant coronary artery narrowing (76-100% XSA) was observed in 63 cases (70.8%), and 51-75% narrowing in 26 cases (29.2%).
- Extensive atherosclerotic plaques, particularly in the left anterior descending artery, were common. Recent thrombosis occurred in 18 cases, plaque hemorrhage in 17.
- Myocardial fibrosis was present in 51 cases; only 2 showed visible acute myocardial infarction. Inflammatory cell infiltration in plaques was noted in 36 cases.
Conclusions:
- Sudden Coronary Death (SCD) is the predominant cause of sudden unexpected death in China, despite a lower overall incidence of coronary heart disease (CHD).
- Severe coronary atherosclerosis, often with thrombosis or plaque hemorrhage, is the primary pathological finding in SCD.
- Middle-aged males are the most affected demographic, with deaths often occurring during sleep, highlighting the need for further research into precipitating factors and preventative strategies.
Abstract:
This paper reports the results of a forensic pathological study of 89 autopsy cases of Sudden Coronary Death (SCD). Of 89 cases, 63 (52 male, 11 female) were narrowed by 76-100% in cross-sectional area (XSA) of the coronary artery (CA) and 26 (22 male, 4 female), by 51-75%. Atherosclerotic plaques in the CA were serious and extensive, especially in the left anterior descending and often involved several branches of CA at the same time. Recent thrombosis was found in 18 cases, haemorrhage in plaques in 17 cases. Only 2 cases had visible acute myocardial infarction. Inflammatory cell infiltration was found in coronary plaques in 36 cases. Myocardial fibrosis or small scar formation was detected in 51 cases. It is suggested that although the incidence of coronary heart disease (CHD) is low in China, SCD is the commonest mode of Sudden Unexpected Death. The majority of SCD (52%) were middle aged males (30-49 years old). Most of the cases died suddenly during sleep without any clear precipitating factors. The characteristics of occurrence and pathological changes in the CA and myocardium and the pathological diagnosis of SCD are also analysed and discussed.