title: Lessons learnt from the autopsies of 445 cases of sudden cardiac death in adults.
abstract: OBJECTIVE
  To determine the cause of sudden cardiac death in adults who underwent autopsy.
  
  
  METHODS
  Four hundred and forty-five sudden cardiac deaths occurred within 1 h of the symptoms onset, and all other cardiac and noncardiac causes having been excluded from autopsy and toxicology screening, were retrospectively identified from among 902 autopsies performed in a 2-year period on the island of Crete. The presence of acute coronary thrombi and myocardial infarction was documented macroscopically and by light microscopy and histology.
  
  
  RESULTS
  In all 445 cases, at least one coronary artery had evidence of moderate to advanced atherosclerosis. About two thirds were between 50 and 70 years. Men had a higher incidence than women, but with advancing age (>60 years) this difference was reduced. Myocardial infarction was found in 17 cases (11 acute; 6 acute and healed). Fifty-eight cases (13.0%) had coronary thrombi, mostly involving the left anterior descending and the right coronary arteries (81%); only six of these were associated with acute myocardial infarction.
  
  
  CONCLUSIONS
  In our population, arrhythmia was the most common cause of sudden cardiac death, while acute coronary thrombi and acute myocardial infarction were detected only in some cases. Because of the heterogeneity in the cause of sudden cardiac deaths in adults, a detailed forensic investigation may provide important information on the cause of death and help in the development of primary and secondary prevention.
authors.affiliation: Department of Forensic Sciences, University of Crete Medical School, Heraklion, Crete, Greece.
authors.forename: Manolis
authors.initials: M
authors.lastname: Michalodimitrakis
authors.forename: Anna
authors.initials: A
authors.lastname: Mavroforou
authors.forename: Athanasios D
authors.initials: AD
authors.lastname: Giannoukas
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001344:Autopsy; D003324:Coronary Artery Disease / Q000473:pathology; D003328:Coronary Thrombosis / Q000473:pathology; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000473:pathology* / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000473:pathology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012737:Sex Factors