title: Autopsy investigation and Bayesian approach to coronary artery disease in victims of motor-vehicle accidents.
abstract: BACKGROUND
  Each year, 1.2 million people die worldwide as a result of motor-vehicle accidents (MVA), representing a tremendous burden to healthcare. The aim of this study was to define the prevalence of coronary disease and its possible role in motor-vehicle accidents.
  
  
  RESULTS
  We examined consecutive cases of non-hospital sudden death autopsies in the area of West Quebec during the period of 2002-2006, and we focused on those victims of MVA. Severe coronary artery disease (CAD) was defined as a narrowing of ≥ 75% of a cross-sectional area or the presence of acute plaque events in major epicardial coronary arteries. From a total cohort of 1260 autopsies, MVA were responsible for 123 deaths, 100 of whom were men and 23 were women. Significant CAD was documented in approximately 37% of these cases. In individuals older than 60 years, the prevalence of significant CAD and ischemia were 86.2% and 19.8%, respectively. A percentage of 40% of the coronary patients showed erratic driving before the accident, as observed by witnesses. Statistical analysis showed that an individual affected by CAD has 9% probability of suffering a motor-vehicle accident.
  
  
  CONCLUSIONS
  The prevalence of severe CAD and acute myocardial ischemia is very high among individuals who have suffered a MVA. Our data suggest the hypothesis that acute CAD could be the cause of accidents in a large group of the drivers affected by coronary disease. For these reasons CAD could be investigated in drivers above 50 years old, as a possible preventive measure and determinant of individual risk stratification.
authors.affiliation: Institute of Forensic Medicine, Catholic University, School of Medicine, Rome, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Oliva
authors.forename: Jose
authors.initials: J
authors.lastname: Flores
authors.forename: Sara
authors.initials: S
authors.lastname: Merigioli
authors.forename: Louis
authors.initials: L
authors.lastname: LeDuc
authors.forename: Begoña
authors.initials: B
authors.lastname: Benito
authors.forename: Sara
authors.initials: S
authors.lastname: Partemi
authors.forename: Dabit
authors.initials: D
authors.lastname: Arzamendi
authors.forename: Oscar
authors.initials: O
authors.lastname: Campuzano
authors.forename: Tack Li
authors.initials: TL
authors.lastname: Leung
authors.forename: Anna
authors.initials: A
authors.lastname: Iglesias
authors.forename: Mario
authors.initials: M
authors.lastname: Talajic
authors.forename: Vincenzo L
authors.initials: VL
authors.lastname: Pascali
authors.forename: Ramon
authors.initials: R
authors.lastname: Brugada
mesh_terms: D000063:Accidents, Traffic / Q000401:mortality; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D050197:Atherosclerosis / Q000473:pathology; D001344:Autopsy; D001499:Bayes Theorem; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000453:epidemiology; D003645:Death, Sudden; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000473:pathology; D058226:Plaque, Atherosclerotic / Q000473:pathology; D015995:Prevalence; D011336:Probability; D011792:Quebec; D012306:Risk