COMPARISON OF SUDDEN AND NONSUDDEN CORONARY DEATHS IN THE UNITED-STATES

Background The present study was designed to compare risk factor preva lences in coronary heart disease deaths in persons dying within 1 hour of onset of cardiovascular symptoms (sudden coronary death), those dy ing without such sudden symptoms (nonsudden coronary death), and those with unknown duration of symptoms before death (other coronary death) . Methods and Results Data from the 1986 National Mortality Followback Survey and the US Bureau of the Census were examined to assess death rates for sudden, nonsudden, and other coronary deaths. Multivariate l ogistic regression methods were used to calculate the odds ratio (OR), compared with nonsudden and other coronary deaths, for sudden coronar y death associated with socioeconomic status variables, the person's l ocation at death, and coronary heart disease risk factors. Mortality r ates for all coronary deaths increased with age, were higher for men t han women, and increased with decreasing years of schooling. The rate of sudden coronary death was highest for Hispanics. In 1986, an estima ted 251000 sudden coronary deaths (95% CI=238000 to 263000) occurred i n the United States. Sudden coronary deaths were less likely than nons udden coronary deaths to occur at home (OR=0.5, 95% CI=0.4 to 0.6), bu t individuals who died of sudden coronary death were more likely to ha ve been current cigarette smokers (OR=1.3, 95% CI=1.0 to 1.8). No othe r modifiable risk factors for coronary heart disease distinguished sud den coronary deaths from nonsudden coronary deaths. Conclusions Contra ry to the commonly held view, coronary deaths in the home are more lik ely to be nonsudden than sudden. Cigarette smoking more likely results in sudden than nonsudden coronary death, perhaps because of nicotine- induced ventricular arrhythmias.