[Out-of-hospital sudden cardiac death: a comparative study spanning 10 years]

Incidence, etiology and time zones of sudden cardiac deaths were compared for 1986 and 1976. Totals of 1,140 cases of acute endogeneous deaths, 590 in 1986 and 550 in 1976, were sent for coroner's inquest in Kanagawa Prefecture. These were the materials for the present study. Sudden cardiac deaths included 239 (46.1%) in 1986 and 137 (37.4%) cases in 1976 in males, and 81 (47.1%) in 1986 and 74 (40.0%) cases in 1976 in females. There were 129 (21.9%) and 163 (29.6%) cases with cerebral hemorrhages in 1986 and 1976, respectively. The acute cardiac death was the most frequent cause among acute endogenous deaths, and it approximately doubled among males during an interval of 10 years. It was related to a marked increase in ischemic heart disease (from 89 to 170 cases) in males compared to a slight increase among females (from 58 to 76 cases). Non-ischemic acute cardiac deaths were frequently noted in males; 38 (27.7%) and 27 (11.4%) cases in 1976 and 1986, respectively. In ischemic heart disease, deaths most frequently occurred about midnight (from 12 a.m. to 1 a.m.) or in the evening (from 5 p.m. to 6 p.m.), and deaths due to acute cardiac failure occurred during sleep. Time zones of evening deaths in ischemic heart disease corresponded to the report of Muller et al., but, the peak about midnight was not reported. This difference may be explained by the circadian rhythm theory, however, heavy alcohol intake and spasmogenicity in the Japanese people may also play roles in midnight deaths.