title: Sudden cardiac death and coronary disease in the young: A nationwide cohort study in Denmark.
abstract: BACKGROUND
  Sudden cardiac death caused by coronary artery disease (CAD-SCD) is the most frequent cause of SCD in persons <50years. The aim of this study was to examine differences in clinical characteristics and autopsy findings of the heart among 18-35 and 36-49year old CAD-SCD cases.
  
  
  METHODS
  We have previously identified all sudden cardiac deaths in Denmark through review of death certificates and autopsy reports including all deaths between 2000 and 2006 in individuals aged 18-35years and all deaths between 2007 and 2009 in individuals aged 18-49years. In this study we included the 197 autopsied CAD-SCD cases. Full autopsy report and medical records from general practitioners and hospitals were obtained.
  
  
  RESULTS
  There was a male predominance (n=151, 76%) and the median age was 42years. In witnessed cases, 51% had a shockable rhythm and 9 cases returned to spontaneous circulation briefly, CAD-SCD victims aged 36-49years had more severe atherosclerosis in all coronary arteries, more multi-vessel disease (29% vs. 15%, p=0.049) and less commonly (38% vs. 54%, p=0.039) acute coronary occlusion than victims <36years. Sixty-eight percent(n=133) of CAD-SCD victims had cardiac symptoms prior to death.
  
  
  CONCLUSIONS
  This nationwide study found several differences in the pathologic lesions of the heart in victims aged 18-35 and 36-49years, which might be associated with different disease progression leading to death in these age groups. We also report a high frequency of cardiac symptoms prior to death in young CAD-SCD cases, which may enable clinicians to prevent these tragic deaths.
authors.affiliation: The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. Electronic address: sara.zachariasardottir@gmail.com.
authors.forename: Sára
authors.initials: S
authors.lastname: Zachariasardóttir
authors.affiliation: The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Bjarke
authors.initials: B
authors.lastname: Risgaard
authors.affiliation: The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Frederik Nybye
authors.initials: FN
authors.lastname: Ågesen
authors.affiliation: The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Reza
authors.initials: R
authors.lastname: Jabbari
authors.affiliation: The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Glinge
authors.affiliation: Department of Forensic Medicine, Aarhus University, Aarhus, Denmark.
authors.forename: Ole
authors.initials: O
authors.lastname: Ingemann-Hansen
authors.affiliation: Department of Forensic Medicine, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Gyda Lolk
authors.initials: GL
authors.lastname: Ottesen
authors.affiliation: Institute of Forensic Medicine, University of Southern Denmark, Odense, Denmark.
authors.forename: Jørgen Lange
authors.initials: JL
authors.lastname: Thomsen
authors.affiliation: Department of Medicine and Surgery, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark; The Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), University of Copenhagen, Copenhagen, Denmark; Laboratory of Molecular Cardiology, Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Stig
authors.initials: S
authors.lastname: Haunsø
authors.affiliation: Department of Forensic Medicine, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Jytte
authors.initials: J
authors.lastname: Banner
authors.affiliation: The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Bo Gregers
authors.initials: BG
authors.lastname: Winkel
authors.affiliation: The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Medicine and Surgery, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Jacob
authors.initials: J
authors.lastname: Tfelt-Hansen
mesh_terms: D000328:Adult; D000367:Age Factors; D001145:Arrhythmias, Cardiac / Q000150:complications / Q000175:diagnosis / Q000401:mortality; D001344:Autopsy / Q000706:statistics & numerical data*; D002423:Cause of Death; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis / Q000401:mortality; D003331:Coronary Vessels / Q000473:pathology*; D003644:Death Certificates; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000209:etiology / Q000473:pathology; D003718:Denmark / Q000453:epidemiology; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008499:Medical Records / Q000706:statistics & numerical data; D008875:Middle Aged; D012720:Severity of Illness Index; D055815:Young Adult
keywords: Autopsy; Coronary artery disease; Epidemiology; Pathology; Sudden cardiac death; Young people