Characteristics of undiagnosed coronary artery disease in sudden cardiac death. Autopsy findings and genetics.

Thesis event information

Date and time of the thesis defence

Place of the thesis defence

Lecture Hall 10, Oulu University Hospital

Topic of the dissertation

Characteristics of undiagnosed coronary artery disease in sudden cardiac death. Autopsy findings and genetics.

Doctoral candidate

Licentiate of Medicine Juha Vähätalo

Faculty and unit

University of Oulu Graduate School, Faculty of Medicine, University of Oulu Graduate School, Faculty of Medicine, Research Unit of Internal Medicine, Medical Research Center Oulu

Subject of study

Medicine

Opponent

Professor Juha Sinisalo, Helsinki University Hospital and University of Helsinki

Custos

Professor Juhani Junttila, Oulu University Hospital and University of Oulu

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Sudden cardiac death as a first manifestation of coronary artery disease and the burden among young adults

The thesis discovered that sudden death caused by coronary artery disease may be associated with a previous silent myocardial infarction and rare genetic variants in some patients. Advanced coronary artery disease was found to be a significant cause of sudden death in young adults.

Coronary artery disease is the most common cause of sudden cardiac death, especially in the elderly. However, its importance has recently been recognized among younger people as well. Unfortunately, sudden death is often the first "symptom" of heart disease. The purpose of this thesis was to study the characteristics of sudden deaths associated with coronary artery disease, especially among younger victims, and those who have not previously been diagnosed with heart disease.

The study was based on the Fingesture data, which consists of all the deceased shown to have died from sudden cardiac death in a forensic autopsy in the region of Northern Finland in 1998–2017.

At autopsies, a myocardial scar was detected in a large proportion of victims of sudden death who had not been diagnosed with coronary artery disease before they died, suggesting a previous silent myocardial infarction. Some of the previously unrecognized myocardial infarctions could possibly have been identifiable from electrocardiograms recorded before death. Some of the victims who were found to have only less advanced coronary artery disease and myocardial hypertrophy at autopsy had a possible gene defect that can potentially cause myocardial disease. Rare genetic variants may potentially increase the risk of sudden death in patients with less advanced coronary artery disease.

Coronary artery disease was also the most common cause of sudden cardiac death in those under 50 years of age, and almost all of them had remained undiagnosed before death. Despite the young age, highly advanced heart disease was a common finding in autopsies. About a third of the victims had at least one cardiovascular risk factor.

The findings of this thesis increase the understanding of sudden deaths related to coronary artery disease, especially among the younger population. In addition, the results provide novel information on the role of silent myocardial infarction and genetics in the risk of sudden death in victims without a previously diagnosed coronary artery disease. Predicting sudden cardiac death is challenging, considering that for a significant proportion of victims, and especially among young population, sudden death is the first manifestation of a heart disease. The results of the study can be used to assess to whom preventive measures could be targeted.
Last updated: 31.5.2022