[Sudden coronary death outside of hospital; an comparative autopsy study of subjects with and without previous cardiovascular diseases].

Autopsy studies of the heart of 221 subjects who suffered pre-hospital coronary sudden death were performed at the Paris Medico-Legal Institute over a period of 3 years to compare the lesions observed in subjects without known cardiovascular disease (Group A: n = 160; 72.4%) with those of subjects with known cardiovascular disease (Group B: n = 61). The proportion of men was greater in Group B (77%) that in Group A (62.5%). The average age of sudden death was the same in both groups: 65 years for men and 77 years for women. Sudden death usually occurred in the home (83%) at rest and, in one third of the cases, during sleep. Sudden death occurred in a context of severe coronary artery disease in both groups: significant triple vessel stenosis (> 75%) in 60% of subjects in both groups but thrombosis was found in only 13% of cases in Group A and 15% of cases in Group B. The mean weight of the heart was significantly greater than normal in both groups and in both sexes. In addition, the mean weight of the heart of subjects in Group B was significantly greater than that of subjects in Group A (p < 0.05). This autopsy study showed that prehospital coronary sudden death was the first sign of coronary disease in 70% of cases. Irrespective of whether the subject had known cardiovascular disease or not, sudden death occurred under similar circumstances and, in both cases, in the context of severe coronary artery disease.