Coronary artery luminal narrowing in the young with sudden unexpected death: a coroner's autopsy study in 350 subjects age 40 years and under.
OBJECTIVE
To describe the extent and distribution of coronary artery luminal narrowing in a Canadian population (aged 40 years and under) dying suddenly and unexpectedly.


METHODS
From a coroner's autopsy population of 350 subjects whose mean age was 28.4 +/- 6.5 years and of whom 250 were male, percentage luminal narrowing was estimated in the four epicardial coronaries. The left main, left anterior descending, left circumflex and right major coronary arteries were sectioned at 5 mm intervals and percentage cross-sectional luminal narrowing from the internal elastic lamina of each segment was estimated microscopically and then graded into four categories: I, 0 to 25%; II, 26 to 50%; III, 51 to 75%; and IV, greater than 75%. A total of 14,611 5 mm segments were evaluated (mean 41.7 per case). The segments were classified as originating from males or females and into three age groups (less than 20, 20 to 29 and 30 to 40 years).


RESULTS
For the entire population, virtually no luminal narrowing greater than 50% was found in patients less than age 20 years, but was found in 3% of segments in the group aged 20 to 29 years and in 8.4% of segments in the group aged 30 to 40 years. In the group aged 20 to 29 years, greater than 50% narrowing was found in 3.8% of segments in males and in 1.2% of segments in females (P < 0.001). In the group aged 30 to 40 years, the corresponding numbers were 10.5% for males and 2.2% in females (P < 0.0001). Eighty-six males (34.4%) had greater than 50% narrowing of at least one coronary artery versus 19 females (19%) (P < 0.01). Left main narrowing of greater than 50% was found in 17 subjects, of which 13 were males. Luminal narrowing was more prevalent in the left anterior descending than the right coronary artery or left circumflex coronary artery and more prevalent in the right coronary artery than the left circumflex coronary artery.


CONCLUSIONS
In subjects less than age 20 years, luminal narrowing greater than 50% was virtually nonexistent. Its frequency progressed in both sexes after age 20 years and was significantly more pronounced in males. Narrowing of the left main coronary artery was more frequent than anticipated and was more common in males.
Mizgala
H F
HF
Department of Pathology, University of British Columbia, Vancouver.
Gray
L H
LH
Ferris
J A
JA
Bociek
V
V
Allard
P
P
Davies
C
C
D000293:Adolescent; D000328:Adult; D001344:Autopsy; D001955:British Columbia / Q000453:epidemiology; D002423:Cause of Death; D003251:Constriction, Pathologic / Q000473:pathology; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000473:pathology*; D003331:Coronary Vessels / Q000473:pathology*; D003645:Death, Sudden / Q000453:epidemiology / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male