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.
Journal of the American College of Cardiology
|April 23, 2026
Summary
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.
Keywords:
MINOCAautopsycoronary artery diseasemyocardial fibrosismyocardial infarctionsudden cardiac deathMore Related Videos
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