OUT-OF-HOSPITAL SUDDEN-DEATH REFERRING TO AN EMERGENCY DEPARTMENT

Over an 11-year period, autopsies were performed on 957 of 1038 nontra umatic deaths in the Emergency Department of the Central Hospital in F errara, Italy. Of these 957 cases, 732 (76.5%) met criteria for sudden death. In 100 (14%) of these cases, the death could be attributed to pulmonary embolism (55 cases), stroke (17), or rupture of aortic aneur ysm (28). Acute myocardial infarction accounted for 403 (55%) of all s udden deaths. Severe coronary artery disease was found in 340 (84%) of these 403 deaths, with plaque fissuring or thrombi in 189 or 151 case s, respectively. Among the 229 sudden deaths for whom no immediate cau se could be determined (31% of the total population), all had evidence of heart disease: 147 individuals had severe coronary artery disease, with plaque fissuring or thrombi found in 72 or 43, respectively. The remaining cases with no immediate cause of death had evidence of a ca rdiomyopathy (61) or valvular disease (21). We conclude that acute myo cardial infarction accounts for the majority of cases of nontraumatic sudden death in our Emergency Department. Altogether, 84% of these pat ients had severe coronary artery disease. In approximately one-third o f cases for whom no immediate cause of sudden death could be determine d, all had evidence of heart disease, and about two-thirds had severe coronary artery disease.