New information revealed on the causes of sudden death associated with coronary artery disease – instead of acute myocardial infarction, the underlying disease is mostly cardiomyopathy

A study by the University of Oulu challenges the prevailing view of the causes of sudden death associated with coronary artery disease. The results recently presented in the most important international publication series in the field of cardiology strongly suggest that traditional myocardial infarction does not play as significant a role in sudden death from coronary artery disease as previously thought.

Myocardial infarction associated with coronary artery disease most often arises from a rupture in the surface of a stenosis on the coronary artery wall, causing the formation of a blood clot and complete or partial blockage of the coronary artery. Previously, this process was considered to be significant in the case of sudden death associated with coronary heart disease, which was thought to be caused either by an acute myocardial infarction or by an arrhythmia triggered by a previous myocardial infarction.

However, in the present study published in the prestigious European Heart Journal, a rupture in the surface of a coronary artery stenosis was found in only one in four people who died suddenly from coronary artery disease. By contrast, almost all the deceased were diagnosed with cardiomyopathy, which is associated with coronary artery disease and involves fibrosis, the accumulation of connective tissue in the thickening myocardium.

The study is based on the FinGesture data, which consists of the deceased shown to have died from sudden cardiac death in a forensic autopsy in Northern Finland in 1998–2017. In total, the FinGesture study has collected data on nearly 6,000 deaths from sudden cardiac death. The histological finding of coronary artery stenosis has been investigated in 600 deceased persons, thereby comprising the material of the current study. This is, as far as is known, the largest research material available internationally where coronary artery stenoses of deceased persons have been examined histologically, i.e. with microscopic samples.

Sudden cardiac death accounts for approximately 10–20% of all deaths, and the majority of the cases are due to coronary artery disease. In the light of cause of death statistics and previous research data, it can be estimated that approximately 4,000–5,000 cases of sudden death caused by coronary artery disease occur annually in Finland.

“Sudden cardiac deaths are always unexpected and cause not only premature loss of life years, but also significant psychosocial strain on people’s next of kin. With this finding, we may be able to better identify coronary artery disease patients at risk and try to prevent sudden deaths in the future,” says doctoral researcher Samuli Juntunen, member of the Clinical Cardiology Research Group.

The research was funded by the state research funding (STM), the Academy of Finland, the Sigrid Jusélius Foundation and the Finnish Foundation for Cardiovascular Research.

Research article: Lauri Holmström, Samuli Juntunen, Juha Vähätalo, Lasse Pakanen, Kari Kaikkonen, Anette Haukilahti, Tuomas Kenttä, Jani Tikkanen, Ville Viitasalo, Juha Perkiömäki, Heikki Huikuri, Robert J Myerburg, Juhani Junttila, Plaque histology and myocardial disease in sudden coronary death: the Fingesture study, European Heart Journal, 2022, ehac533,

Last updated: 10.10.2022