Temporal Trends in the Clinical and Pathological Characteristics of Victims of Sudden Cardiac Death in the Absence of Previously Identified Heart Disease.
Coronary artery disease is identified in ≈80% of victims of sudden cardiac death (SCD). Because the prevention strategies and public awareness have changed during the past decades, we studied the temporal trends in the pathogenesis of SCD.



FinGesture (n=4031) is a prospective study designed to classify the phenotype and genotype profiles of SCD in a consecutive series of victims of SCD in Northern Finland. On the basis of Finnish law, all subjects who die suddenly undergo autopsy. We analyzed the characteristics of SCD victims and autopsy findings in 1998 to 2002, 2003 to 2007, and 2008 to 2012. Among victims of SCD as a first cardiac event (n=2697), the proportion with coronary artery disease decreased during the 2008 to 2012 time period, compared with the 2 preceding 5-year periods: 74.0% in 1998 to 2002, 73.1% in 2003 to 2007, and 66.4% in 2008 to 2012 (P<0.001). Proportion of SCDs associated with hypertensive heart disease with left ventricular hypertrophy in the absence of coronary artery disease increased from 1.7% in 1998 to 2002 to 5.8% in 2003 to 2007 and 8.9% in 2008 to 2012 (P<0.001). Similarly, myocardial fibrosis in the absence of myocarditis or left ventricular hypertrophy, or other known pathogeneses, was 6.7% in the past 5-year period compared with 2 previous 5-year periods (3.7% and 4.0%; P<0.001 between 1998-2002 and 2008-2012 and between 2003-2007 and 2008-2012).



The proportion of SCDs attributable to coronary artery disease, in the absence of a history of heart disease, has decreased, whereas the proportion associated with hypertensive heart disease and idiopathic fibrosis has increased during the past 15 years.
From the Research Unit of Internal Medicine, Medical Research Center Oulu (M.J.J., E.H., K.S.K., H.V.H.) and Department of Forensic Medicine (M.-L.K.), University of Oulu, Oulu, Finland; and Division of Cardiology, Miller School of Medicine, University of Miami, FL (R.J.M.). juhani.junttila@oulu.fi.
M Juhani
MJ
Junttila
From the Research Unit of Internal Medicine, Medical Research Center Oulu (M.J.J., E.H., K.S.K., H.V.H.) and Department of Forensic Medicine (M.-L.K.), University of Oulu, Oulu, Finland; and Division of Cardiology, Miller School of Medicine, University of Miami, FL (R.J.M.).
Eeva
E
Hookana
From the Research Unit of Internal Medicine, Medical Research Center Oulu (M.J.J., E.H., K.S.K., H.V.H.) and Department of Forensic Medicine (M.-L.K.), University of Oulu, Oulu, Finland; and Division of Cardiology, Miller School of Medicine, University of Miami, FL (R.J.M.).
Kari S
KS
Kaikkonen
From the Research Unit of Internal Medicine, Medical Research Center Oulu (M.J.J., E.H., K.S.K., H.V.H.) and Department of Forensic Medicine (M.-L.K.), University of Oulu, Oulu, Finland; and Division of Cardiology, Miller School of Medicine, University of Miami, FL (R.J.M.).
Marja-Leena
ML
Kortelainen
From the Research Unit of Internal Medicine, Medical Research Center Oulu (M.J.J., E.H., K.S.K., H.V.H.) and Department of Forensic Medicine (M.-L.K.), University of Oulu, Oulu, Finland; and Division of Cardiology, Miller School of Medicine, University of Miami, FL (R.J.M.).
Robert J
RJ
Myerburg
From the Research Unit of Internal Medicine, Medical Research Center Oulu (M.J.J., E.H., K.S.K., H.V.H.) and Department of Forensic Medicine (M.-L.K.), University of Oulu, Oulu, Finland; and Division of Cardiology, Miller School of Medicine, University of Miami, FL (R.J.M.).
Heikki V
HV
Huikuri
D001344:Autopsy; D002423:Cause of Death; D003324:Coronary Artery Disease / Q000150:complications / Q000453:epidemiology; D016757:Death, Sudden, Cardiac / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D005387:Finland / Q000453:epidemiology; D005838:Genotype; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000453:epidemiology; D017379:Hypertrophy, Left Ventricular / Q000150:complications / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D011446:Prospective Studies; D012307:Risk Factors
coronary artery disease; fibrosis; heart disease; hypertrophy; sudden cardiac death