Dataset Information

Plaque histology and myocardial disease in sudden coronary death: the Fingesture study.

ABSTRACT:

Aims

At least 50% of deaths due to coronary artery disease (CAD) are sudden cardiac deaths (SCDs), but the role of acute plaque complications on the incidence of sudden death in CAD is somewhat unclear. The present study aimed to investigate plaque histology and concomitant myocardial disease in sudden coronary death.

Methods and results

The study population is derived from the Fingesture study, which has collected data from 5869 consecutive autopsy-verified SCD victims in Northern Finland (population ≈600 000) between 1998 and 2017. In this substudy, histological examination of culprit lesions was performed in 600 SCD victims whose death was due to CAD. Determination of the cause of death was based on the combination of medical records, police reports, and autopsy data. Plaque histology was classified as either (i) plaque rupture or erosion, (ii) intraplaque haemorrhage, or (iii) stable plaque. The mean age of the study subjects was 64.9 ± 11.2 years, and 82% were male. Twenty-four per cent had plaque rupture or plaque erosion, 24% had an intraplaque haemorrhage, and 52% had a stable plaque. Myocardial hypertrophy was present in 78% and myocardial fibrosis in 93% of victims. The presence of myocardial hypertrophy or fibrosis was not associated with specific plaque histology.

Conclusion

Less than half of sudden deaths due to CAD had evidence of acute plaque complication, an observation which is contrary to historical perceptions. The prevalence of concomitant myocardial disease was high and independent of associated plaque morphology.

SUBMITTER: Holmstrom L

PROVIDER: S-EPMC9748531 | biostudies-literature | 2022 Dec

REPOSITORIES: biostudies-literature

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Publications

Plaque histology and myocardial disease in sudden coronary death: the Fingesture study.

Holmström Lauri L Juntunen Samuli S Vähätalo Juha J Pakanen Lasse L Kaikkonen Kari K Haukilahti Anette A Kenttä Tuomas T Tikkanen Jani J Viitasalo Ville V Perkiömäki Juha J Huikuri Heikki H Myerburg Robert J RJ Junttila Juhani J

European heart journal 20221201 47

<h4>Aims</h4>At least 50% of deaths due to coronary artery disease (CAD) are sudden cardiac deaths (SCDs), but the role of acute plaque complications on the incidence of sudden death in CAD is somewhat unclear. The present study aimed to investigate plaque histology and concomitant myocardial disease in sudden coronary death.<h4>Methods and results</h4>The study population is derived from the Fingesture study, which has collected data from 5869 consecutive autopsy-verified SCD victims in Norther ...[more]

PMID: 36172703

Similar Datasets

Project description:ImportanceThe majority of sudden and/or arrhythmic deaths (SAD) in patients with coronary heart disease occur in those without severe systolic dysfunction, for whom strategies for sudden death prevention are lacking.ObjectiveTo provide contemporary estimates of SAD vs other competing causes of death in patients with coronary heart disease without severe systolic dysfunction to search for high-risk subgroups that might be targeted in future trials of SAD prevention.Design, setting, and participantsThis prospective observational cohort study included 135 clinical sites in the United States and Canada. A total of 5761 participants with coronary heart disease who did not qualify for primary prevention implantable cardioverter defibrillator therapy based on left ventricular ejection fraction (LVEF) of more than 35% or New York Heart Association (NYHA) heart failure class (LVEF >30%, NYHA I).ExposuresClinical risk factors measured at baseline including age, LVEF, and NYHA heart failure class.Main outcomes and measuresPrimary outcome of SAD, which is a composite of SAD and resuscitated ventricular fibrillation arrest.ResultsThe mean (SD) age of the cohort was 64 (11) years. During a median of 3.9 years, the cumulative incidence of SAD and non-SAD was 2.1% and 7.7%, respectively. Sudden and/or arrhythmic death was the most common mode of cardiovascular death accounting for 114 of 202 cardiac deaths (56%), although noncardiac death was the primary mode of death in this population. The 4-year cumulative incidence of SAD was lowest in those with an LVEF of more than 60% (1.0%) and highest among those with LVEF of 30% to 40% (4.9%) and class III/IV heart failure (5.1%); however, the cumulative incidence of non-SAD was similarly elevated in these latter high-risk subgroups. Patients with a moderately reduced LVEF (40%-49%) were more likely to die of SAD, whereas those with class II heart failure and advancing age were more likely to die of non-SAD. The proportion of deaths due to SAD varied widely, from 14% (18 of 131 deaths) in patients with NYHA II to 49% (37 of 76 deaths) in those younger than 60 years.Conclusions and relevanceIn a contemporary population of patients with coronary heart disease without severe systolic dysfunction, SAD accounts for a significant proportion of overall mortality. Moderately reduced LVEF, age, and NYHA class distinguished SAD and non-SAD, whereas other markers were equally associated with both modes of death. Absolute and proportional risk of SAD varied significantly across clinical subgroups, and both will need to be maximized in future risk stratification efforts.

Dataset Information

Plaque histology and myocardial disease in sudden coronary death: the Fingesture study.

Aims

Methods and results

Conclusion

Publications

Plaque histology and myocardial disease in sudden coronary death: the Fingesture study.

Similar Datasets

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