Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark; Department of Forensic Medicine, Copenhagen University, Copenhagen, Denmark.
Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark; Department of Forensic Medicine, Copenhagen University, Copenhagen, Denmark.
Heart Rhythm. 2023 Nov;20(11):1504-1509. doi: 10.1016/j.hrthm.2023.07.005. Epub 2023 Jul 14.
More than half of all sudden cardiac deaths (SCDs) are unwitnessed, but the composition of the unwitnessed SCD population is poorly described.
The purpose of this study was to compare clinical and autopsy characteristics of young unwitnessed SCD subjects, based on the time from last contact to being found dead.
All unwitnessed SCD subjects aged 1-35 years in Denmark from 2000-2014 identified through a multisource approach were included. Time from last seen alive to being found dead was dichotomized to <1 hour or 1-24 hours. Clinical characteristics and autopsy results were compared, and predictors of autopsy were assessed by logistic regression.
Of 440 unwitnessed SCD subjects, 366 (83%) had not been seen alive within 1 hour of being found dead. Comorbidities differed between the groups, with more epilepsy (17% vs 5%) and psychiatric diseases (13% vs 7%) in the 24-hour group. Patients in the 24-hour group died more frequently during sleep (64% vs 23%), the autopsy rate was higher (75% vs 61%), and deaths were more often unexplained after autopsy (69% vs 53%). Having been seen within 1 hour of death independently decreased the chance of being autopsied (odds ratio 0.51; 95% confidence interval 0.27-1.00; P = .0497).
The majority of unwitnessed SCD subjects had not been seen alive within 1 hour of being found dead. Clinical- and autopsy-related characteristics differed between the 2 groups. Differences were mainly attributable to death-related circumstances and comorbidities. Excluding SCD cases not seen alive within 1 hour of being found dead would severely underestimate the burden of SCD.
超过一半的心脏性猝死（SCD）是无人见证的，但无人见证的 SCD 人群的构成情况描述得很差。
本研究旨在根据从最后一次见到活着到被发现死亡的时间，比较年轻的无人见证的 SCD 患者的临床和尸检特征。
通过多源方法在丹麦确定了 2000 年至 2014 年期间年龄在 1-35 岁之间的所有无人见证的 SCD 患者。从最后一次活着到被发现死亡的时间被分为<1 小时或 1-24 小时。比较了临床特征和尸检结果，并通过逻辑回归评估了尸检的预测因素。
在 440 名无人见证的 SCD 患者中，有 366 名（83%）在被发现死亡前不到 1 小时内未被看到活着。两组之间的合并症不同，24 小时组中癫痫（17%比 5%）和精神疾病（13%比 7%）更为常见。24 小时组患者在睡眠中死亡更为常见（64%比 23%），尸检率更高（75%比 61%），且尸检后死因不明的情况更为常见（69%比 53%）。在死亡后 1 小时内被看到独立降低了进行尸检的机会（比值比 0.51；95%置信区间 0.27-1.00；P=0.0497）。
大多数无人见证的 SCD 患者在被发现死亡前不到 1 小时内没有被看到活着。两组之间的临床和尸检相关特征不同。差异主要归因于与死亡相关的情况和合并症。排除在被发现死亡前不到 1 小时内未被看到活着的 SCD 病例将严重低估 SCD 的负担。
