Sudden Cardiac Death Due to Myocardial Infarction With Obstructive and Nonobstructive Coronary Arteries
Kosuke Nakasuka1, Jakrin Kewcharoen1, James W Salazar1
1Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA.
Insights
Sudden cardiac deaths (SCDs) due to myocardial infarction (MI) account for 41% of autopsy-confirmed cases, with significant racial disparities. Myocardial infarction with nonobstructive coronary arteries (MINOCA) had more nonarrhythmic causes than MI with obstructive coronary artery disease (MI-CAD).
Area of Science:
- Cardiology
- Pathology
- Public Health
Background:
- The overall impact of myocardial infarction (MI) on community sudden cardiac deaths (SCDs), including cases with nonobstructive coronary arteries (MINOCA), remains incompletely understood.
- Determining the precise burden of MI-related SCD is crucial for public health initiatives and clinical risk stratification.
Purpose of the Study:
- To quantify the burden of community SCD attributed to MI using comprehensive histopathological examination.
- To investigate the characteristics of MI-related SCD, differentiating between obstructive and nonobstructive coronary artery disease.
Main Methods:
- The study utilized data from the Postmortem Systematic Investigation of Sudden Cardiac Death (POST SCD) study, a prospective, countywide autopsy-based investigation.
- Cases were adjudicated as SCD due to MI if histopathological findings confirmed MI without other lethal causes. Obstructive coronary artery disease was defined as ≥50% stenosis in at least one coronary artery.
Main Results:
- Of 943 presumed SCDs, 583 (62%) were autopsy-confirmed SCDs, with 237 (41%) attributed to MI (MI SCD).
- Acute myocardial infarction with nonobstructive coronary arteries (MINOCA) constituted 10% of MI SCDs, with a higher proportion observed among Black patients.
- The left anterior descending and right coronary arteries were most frequently affected in MI-CAD SCDs, with the right coronary artery being the most common culprit vessel.
Conclusions:
- Myocardial infarction (MI) accounts for a substantial proportion (41%) of autopsy-confirmed sudden cardiac deaths (SCDs), with notable racial variations.
- Nonarrhythmic causes were more prevalent in MINOCA SCDs compared to MI with obstructive coronary artery disease (MI-CAD) SCDs.
- These findings underscore the importance of histopathological examination in accurately determining the causes of SCD and highlight potential disparities in MI-related cardiac events.
Background:
The total burden of community sudden cardiac deaths (SCDs) attributable to myocardial infarction (MI), including myocardial infarction with nonobstructive coronary arteries (MINOCA), is unclear.
Objectives:
The study sought to determine the burden of community SCD due to MI by histopathologic examination.
Methods:
The POST SCD (Postmortem Systematic Investigation of Sudden Cardiac Death) study is a prospective countywide study using autopsy to adjudicate presumed SCDs as cardiac (arrhythmic or nonarrhythmic) or noncardiac causes, with trauma deaths as reference control deaths. We defined a case as "SCD due to MI" if histopathological findings of MI without other lethal cause were found, and defined obstructive coronary artery disease as ≥50% stenosis in ≥1 coronary artery.
Results:
Of 943 presumed SCDs from February 1, 2011, to March 31, 2023, 360 (38%) had noncardiac cause and 583 (62%) were autopsy-confirmed SCDs, of which 237 (41%) were due to MI (MI SCD): 214 (90%) were acute or healed myocardial infarction with obstructive coronary artery disease (MI-CAD) and 23 (10%) were acute MINOCA (highest proportion among Black patients; P < 0.05). Among 173 coronary lesions in acute MI-CAD SCDs (n = 95), the left anterior descending artery (n = 66 [38%]) and right coronary artery (n = 59 [35%]) were most commonly affected, and the right coronary artery was the most common culprit (43%). Nonarrhythmic causes were more common in MINOCA than acute MI-CAD SCDs (35% vs 15%; P = 0.037), with a trend toward being the highest in Asian patients (P = 0.1). The total fibrosis burden was similar in MINOCA and acute MI-CAD SCDs (P = 0.6).
Conclusions:
In this 12-year countywide study, one-fourth of all sudden deaths and 41% of autopsy-confirmed SCDs were attributable to MI, with significant racial differences. The left anterior descending artery and right coronary artery were most commonly affected among SCDs due to MI-CAD. Nonarrhythmic causes were twice as common in MINOCA SCDs than acute MI-CAD.
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