The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Section 2142, Blegdamsvej 9, 2100 Copenhagen, Denmark.
Section of Forensic Pathology, Department of Forensic Medicine, Copenhagen University, Copenhagen, Denmark.
Europace. 2021 Jun 7;23(6):898-906. doi: 10.1093/europace/euab017.
The aim of this study is to compare clinical characteristics and causes of death among witnessed and unwitnessed sudden cardiac death (SCD) cases aged 1-35 years.
In this retrospective nationwide study, all deaths in persons aged 1-35 years in Denmark during 2000-09 were included (23.7 million person-years). Using the in-depth descriptive Danish death certificates and Danish nationwide registries, 860 cases of sudden, unexpected death were identified. Through review of autopsy reports and register data, we identified 635 cases of SCD of which 266 (42%) were witnessed and 326 (51%) were unwitnessed. In 43 cases (7%), witnessed status was missing. Clinical characteristics were overall similar between the two groups. We found a male predominance among unwitnessed SCD compared to witnessed SCD (71% and 62%, respectively, P-value 0.012), as well as more psychiatric comorbidity (20% and 13%, respectively, P-value 0.029). Unwitnessed SCD more often occurred during sleep whereas witnessed SCD more often occurred while the individual was awake and relaxed (P-value < 0.001). The autopsy rate among all SCD cases was 70% with no significant difference in autopsy rate between the two groups. Sudden unexplained death, which was the leading autopsy conclusion in both groups, was more frequent among unwitnessed SCD (P-value 0.001).
Several clinical characteristics and autopsy findings were similar between witnessed and unwitnessed SCD cases. Our data support the inclusion of both witnessed and unwitnessed cases in epidemiological studies of SCD cases aged 1-35 years, although the risk of misclassification is higher among unwitnessed and non-autopsied cases of SCD.
本研究旨在比较 1-35 岁有目击者和无目击者的心脏性猝死（SCD）患者的临床特征和死因。
在这项回顾性全国性研究中，纳入了丹麦 2000-09 年期间年龄在 1-35 岁之间的所有死亡病例（2370 万人年）。使用详细的丹麦死亡证明和丹麦全国性登记册，确定了 860 例突发、意外死亡病例。通过审查尸检报告和登记册数据，我们确定了 635 例 SCD 病例，其中 266 例（42%）有目击者，326 例（51%）无目击者。在 43 例（7%）病例中，目击者情况缺失。两组患者的临床特征总体相似。我们发现无目击者 SCD 中男性比例高于有目击者 SCD（分别为 71%和 62%，P 值=0.012），且合并精神疾病的比例更高（分别为 20%和 13%，P 值=0.029）。无目击者 SCD 更多发生在睡眠期间，而有目击者 SCD 更多发生在个体清醒和放松时（P 值<0.001）。所有 SCD 病例的尸检率为 70%，两组之间的尸检率无显著差异。猝然不明原因死亡是两组中的主要尸检结论，无目击者 SCD 中更常见（P 值=0.001）。
有目击者和无目击者 SCD 患者的一些临床特征和尸检结果相似。我们的数据支持将有目击者和无目击者的 SCD 病例纳入 1-35 岁 SCD 病例的流行病学研究中，尽管无目击者和未经尸检的 SCD 病例的分类错误风险更高。
