title: Sudden cardiac death in South India: Incidence, risk factors and pathology.
abstract: BACKGROUND
  Sudden cardiac death (SCD) is a major cause of mortality secondary to coronary artery disease (CAD) in the industrialized societies. Although South Asians have a high prevalence of CAD, the frequency and underlying pathology of SCD among this population are unknown.
  
  
  METHODS
  Medical records of consecutive patients presenting with unexplained sudden death (USD) in a tertiary care center were reviewed. Patients with trauma, violent deaths, positive toxicology and non-cardiac pathology were excluded to determine sudden cardiac death (SCD). Cardiac pathological findings were analyzed by autopsy. SCD rate was estimated based on census and government vital statistics for the years studied.
  
  
  RESULTS
  During a two year period, 223 patients (mean age 55 + 10 yrs, 78.9% male, body mass index 26 + 4, 60% smokers, 39% known CAD, 46% hypertension, 43% diabetes) presented to hospital with USD. SCD was attributed to myocardial infarction (MI) in 87% of cases; 69% were acute (96% anterior MI); 76% were small/moderate infarct and 9.9% of the cohort had normal hearts. Based on official municipal vital statistics, the SCD rate in those >35 yrs of age was estimated as 39.7/100,000 with male/female ratio of 4.6.
  
  
  CONCLUSIONS
  SCD in this south Indian city occurred predominantly in men of relatively young age and was most frequently associated with small or moderate-sized acute MI. Improved health care access, preventive measures and enhanced emergency management may reduce SCD from acute MI in this locale.
authors.affiliation: University of California (Davis) Medical Center, Sacramento, CA, United States. Electronic address: unsrivatsa@ucdavis.edu.
authors.forename: Uma N
authors.initials: UN
authors.lastname: Srivatsa
authors.affiliation: Tirunelveli Medical College, Tirunelveli, India.
authors.forename: K
authors.initials: K
authors.lastname: Swaminathan
authors.affiliation: Tirunelveli Medical College, Tirunelveli, India.
authors.forename: K
authors.initials: K
authors.lastname: Sithy Athiya Munavarah
authors.affiliation: University of California (Davis) Medical Center, Sacramento, CA, United States.
authors.forename: Ezra
authors.initials: E
authors.lastname: Amsterdam
authors.affiliation: Tirunelveli Medical College, Tirunelveli, India.
authors.forename: K
authors.initials: K
authors.lastname: Shantaraman
keywords: Autopsy; Risk factors; South India; Sudden cardiac death