Non-Atherosclerotic Coronary Artery Pathology Responsible for Sudden Cardiac Death
MN Sheppard, SF Hill. Royal Brompton Hospital, Imperial College, London, United Kingdom
Background: Most sudden cardiac deaths (SCD) are due to ischemic heart disease. The concept of non-atherosclerotic coronary artery pathology in sudden death has not been given the attention it deserves. We sought to determine the incidence of this entity and raise awareness amongst cardiologists and pathologists alike. Since 1992, the Royal Brompton Hospital has been a referral centre for SCD in the United Kingdom. We have established a database of 1,800 SCD hearts.
Design: Retrospective study of hearts with non-atherosclerotic coronary artery causes of sudden death with detailed histological analysis.
Results: Fifty (2.7%) of the 1,800 cases of SCD were caused by non-atherosclerotic coronary pathology (31 men (62%) and 19 women (38%, age range [8 weeks-71 years]). Twenty- four of the 50 cases had anomalous coronary arteries (48%); eight cases had coronary artery dissection (16%); six cases had coronary artery vasculitis (12%); six cases had coronary artery spasm (12%); three cases had idiopathic arterial calcification of infancy (6%); two cases had fibromuscular dysplasia (4%) and one case had a benign tumour occluding the left coronary ostium (2%). Twenty of the 50 patients (40%) were documented to have experienced symptoms such as syncope, chest pain on exertion or breathlessness prior to their SCD. Twelve of the patients (24%) died during or immediately after physical exertion.
Conclusions: Non-atherosclerotic coronary pathology can cause sudden death in all age groups particularly younger, male patients. Cardiologists need to be aware of these entities and investigate any patient who has cardiac symptoms especially with exertion.
Tuesday, March 10, 2009 1:00 PM
Poster Session IV # 48, Tuesday Afternoon