Sudden cardiac death: a diversity of causes with focus on atherosclerotic coronary artery disease.

There are many causes of sudden cardiac death, and the younger the patient the more diverse the cause. Among persons dying suddenly in the Western World atherosclerotic coronary artery disease is the most common. This group might best be called atherosclerotic sudden coronary death. This article summarizes a previously published necropsy study by Warnes and Roberts of 70 victims aged 22 to 81 years (mean 50) of sudden coronary death. Of 3,484 five-mm coronary segments examined (mean 50 per patient) from the 4 major (left main, left anterior descending, left circumflex and right) coronary arteries, 950 (27%) were narrowed 76 to 100% in cross-sectional area by plaque; 1,127 (32%), 51 to 75%; 689 (20%), 26 to 50%, and 718 (21%), 0 to 25%. More extensive severe narrowing occurred in the proximal compared with the distal halves to the left anterior descending, left circumflex and right coronary arteries. Comparison between the 31 previously symptomatic victims (either angina pectoris and/or a clinical acute myocardial infarction) to the 39 victims who had previously been asymptomatic disclosed a significantly higher mean percent of severely (76 to 100% in cross-sectional area) narrowed 5-mm segments (30 vs 25% [p less than 0.0051]) and a lower mean percent of minimally (0 to 25%) narrowed segments in the symptomatic group (15 vs 25%, p less than 0.001). Thus, the major coronary arteries at necropsy in victims of sudden coronary death are diffusely involved by atherosclerotic plaque and in nearly one-third of the lengths of the major arteries the lumens are narrowed greater than 75% in cross-sectional area by plaque.(ABSTRACT TRUNCATED AT 250 WORDS)