PREHOSPITAL CORONARY SUDDEN-DEATH - A COM PARATIVE-STUDY OF SUBJECTS WITH AND WITHOUT PREVIOUS CARDIOVASCULAR-DISEASE

Autopsy studies of the heart of 221 subjects who suffered pre-hospital coronary sudden death were performed at the Paris Medico-Legal Instit ute over a period of 3 years to compare the lesions observed in subjec ts without known cardiovascular disease (Group A : n = 160 ; 72.4 %) w ith those of subjects with known cardiovascular disease (Group B : n = 61). The proportion of men was greater in Group B (77 %) that in Grou p A (62.5 %). The average age of sudden death was the same in both gro ups : 65 years for men and 77 years for women. Sudden death usually oc curred in the home (83 %) at rest and, in one third of the cases, duri ng 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 o f the heart was significantly greater than normal in both groups and i n 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 d eath was the first sign of coronary disease in 70 % of cases. Irrespec tive of whether the subject had known cardiovascular disease or not, s udden death occurred under similar circumstances and, in both cases, i n the context of severe coronary artery disease.