予期的な郡全体の監視と急性心臓死亡の解剖特徴: POST SCD研究
Zian H Tseng1, Jeffrey E Olgin2, Eric Vittinghoff3
1Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine (Z.H.T., J.E.O.) zhtseng@medicine.ucsf.edu.
Circulation
|June 20, 2018
まとめ
急性心臓死 (SCD) の発生率は,推測された原因に依存しているため,不明です. 解剖は,推定SCDのほぼ半分が不律ではないことを明らかにし,現在の定義の不正確さを強調します.
科学分野:
- 心臓病科
- 法医病理学
- 公衆衛生
背景:
- 急性心臓死 (SCD) の発生率は,緊急医療サービス記録と死亡証明書に依存しているため,過小評価されています.
- SCDの90%以上は病院外で発生し,原因はしばしば不定期な解剖によるものと推定されます.
研究 の 目的:
- 都市部におけるすべての突然心臓死 (SCD) の正確な発生率と解剖による原因を決定する.
- 死後の検査で,突然の不律性死が実際に発生したかどうかを調べる.
主な方法:
- サンフランシスコ郡で3年間,病院外での心臓発作死亡 (18~90歳) の見込みの特定.
- 検死医による解剖,毒理学,組織学; 世界保健機関 (WHO) のSCD基準が適用された.
- 死証の見直しと,多学科委員会による判断
主要な成果:
- 病院外での心臓発作停止の912例のうち541例 (59%) がWHOのSCD基準を満たし,525例が解剖された.
- 主な原因は冠動脈疾患 (32%),オカルト過剰摂取 (13. 5%),心筋病 (10%) であった.
- 死体解剖で定義された突然発作死亡は,WHOで定義されたSCDの55. 8%を占め,その98%が構造的な心臓疾患を示した.
結論:
- 心臓発作 の 死亡 の 40% は 突発 的 な もの で は なく,予期 さ れ ない もの で は あり ませ ん.推定 さ れ て いる SCD の 半数 近く は 心律 乱 で は あり ませ ん.
- 死亡率データ,臨床試験,コホート研究におけるSCDに対するWHOの基準と緊急医療サービスの記録の正確さに疑問を投げかけている.
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