Sudden Cardiac Death in Nineveh Governorate (Iraq) during the years (2010 and 2011) (Retrospective Postmortem Study)

Abstract

Background: Sudden cardiac death (SCD) is an important challenging medical problem. It is defined as death occurring within 24 hours of an abrupt change in previous clinical status, ruling out all potentially lethal non- cardiac causes. The variability of incidence and causes of SCD in different population and absence of data in our locality, motivate us to conduct this study. Objectives: We aim to calculate the incidence of SCD in Nineveh city, to find the underlying causes of SCD, and to study the coronary heart disease (CHD) in regard to the severity of atherosclerosis, number and type of vessels involved and the evidence of myocardial ischemia in different age groups and genders. Patients and methods: The total number of SCD cases above 15 year in Nineveh during 2 years was 584. The autopsy and histo-pathological reports of 99 SCD cases were analyzed. The lesions of atherosclerosis were graded as mild, moderate and severe. Chi- square test was used for statistical analysis. Results: The incidence of SCD in Nineveh is 17.6 in 100 000, aged 15–75 year. Sixty four percent were less than 40y. Male: female ratio 9:1. CHD attributed to (58%) of SCD, non-atheromatous causes (24%), and normal autopsy (18%). The causes of SCD are different before and after 40 y (p= 0.000), (83%) of CHD aged above 40y, while (83, 88%) of Non-atheromatous and normal autopsy were less than 40 y. The atherosclerotic changes were severe in (49%) and moderate in (37%). Severity of lesion was correlated with number of vessels involved. Left anterior descending artery was most frequently and severely involved. Only (7%) show new myocardial ischemia, old ischemia found in (32%). There was no difference neither in severity, number and type of vessels nor in the myocardial ischemia between the age groups. Conclusion: CHD is the most important cause of SCD in males of all ages, and it is the major cause of death above 40 years, this is comparable with Caucasians and Asians population and similar to previous studies. Moderate to severe atherosclerosis found in (80%) of CHD and the myocardium is normal in most of cases.