Prehospital sudden death from ischaemic heart disease. A postmortem study.

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Abstract
A detailed postmortem study of the myocardium and coronary arteries was performed on 114 men and 37 women who died suddenly. Data on the disease history and certain risk factors were collected through an Ischemic Heart Disease Register. Men and women did not differ with respect to previous symptoms of ischemic heart disease or necropsy findings. A history of hypertension and the previous use of digitalis or diuretics tended to be more frequent in women than in men but current smoking was more common in men (69%) than in women (43%). Of the subjects in whom necropsy revealed an old myocardial infarction, 86% had a history of symptomatic ischemic heart disease but a previous myocardial infarction was known in only 42%. A definite recent myocardial infarction was found in 26% and an early infarction in 51%. About half of the patients with a definite recent or an early myocardial infarction and half of those with no recent myocardial infarct, died at once. Of the subjects, 14% died after symptoms lasting 2 h or more. Triple vessel disease in the coronary arteries was found in 56% of cases, double vessel disease in 31% and single vessel disease in 11%. Aortic valvular stenosis or a history of hypertension was present in 3 cases with no obvious coronary disease. Suddenness of death did not correlate with severity of coronary obstruction. Arterial lesions were more severe in patients with an old myocardial infarction than in those without this. The more severe the coronary artery disease, the more likely a definite recent myocardial infarction was present. The mildest disease was found in patients with no detectable recent myocardial infarction. No significant differences were found between patients with symptomatic and those with silent but definite myocardial infarction. Heavy smoking was most common in patients with an early recent myocardial infarction. Patients dying without warning and with no recent infarction (those with a primary arrhythmia) had severe coronary artery disease less frequently than those dying with a recent infarction. None of the former were heavy smokers. They had large scarred hearts and a high incidence of previous hypertension, of ischemic heart disease and of treatment with digitalis or diuretics.