Fotios CHATZİNİKOLAOU, Aspasia DELİLİGKA, Dimitrios KOUTSOUKİS, İoannis CHRYSOVERGİS, Evangelia KARACHALİOU, George J. KARAMPOUTAKİS, Christina OUZOUNİ, Konstantinos NAKAKİS, Konstantinos KOUTSAMPASOPOULOS

Ani ölüm ve koroner kalp hastalığı: geriye dönük bir otopsi çalışması

Amaç: Bu çalışmada, bilinen koroner kalp hastalığı olan veya olmayan ve aniden ölen kişilerde miyokard enfarktüsünün ne sıklıkta bulunduğunu belirlenmesi ve ateromatozun ciddiyetinin cinsiyet ve yaşla ilişkisinin saptanması amaçlanmıştır. Gereç ve Yöntem: Bir yıl içinde ani ölüm sonrası otopsisi yapılan 184 erişkin olgunun klinik kayıtlarından elde edilen veriler kullanılarak retrospektif bir çalışma tasarlanmıştır. Demografik özellikleri, mevsimi ve ölüm yerleri incelendi. Semptomlar, sigara, alkol ve uyuşturucu kullanımı ile ölüm koşulları da kaydedildi. Koroner arter bulguları, kalp ağırlığı, miyokard infarktüsünün lokalizasyonu ve eski miyokard infarktüsü varlığı otopsi raporlarından alınmıştır.Bulgular: 92 hasta (54 erkek, 38 kadın, yaş ortalaması 64.8), çalışmaya dahil edilme kriterlerini karşıladı. Otopsi sırasında olguların çoğunda (%92.4) akut miyokard infarktüsü onaylandı. Saptanan olgularda koroner arter lezyonlarının derecelendirme şiddetleri; çoğunda şiddetli (%75) ve sadece iki vakada normal olarak tespit edildi. Erkeklerin, koroner arterlerde kadınlara göre orta veya şiddetli lezyonlara sahip olma olasılığı daha yüksekti. Yaşlı kurbanlarda şiddetli ateromatozis daha sık saptanmıştır.Sonuç: Akut miyokard enfeksiyonu, ani kardiyak ölümü kurbanları arasında yaygın bir otopsi bulgusudur. Yaşlı miyokard enfeksiyonu da birçok vakada tanımlanabilir ve ateromatik lezyonların şiddeti yaşa göre artabilir.

Anahtar Kelimeler:

ani ölüm, koroner kalp hastalıkları

Sudden death and coronary heart disease: findings from a retrospective autopsy study

Purpose: The aim of this study was to examine how often myocardial infarction in abruptly dying persons with or without known coronary heart disease could be found as well as to estimate the severity of atheromatosis in correlation to gender and age. Materials and Methods: A retrospective study was designed using data from clinical records of 184 cases of adults who submitted with sudden death and underwent autopsy during a period of one year. We studied the demographic characteristics, season and location of death. Symptoms, smoking, alcohol and drug use, circumstances of death were also record. Coronary arteries findings in autopsy, heart weight, localization of myocardial infarction and the presence of an old myocardial infraction were record from autopsy report. Results: 92 patients (54 male, 38 female mean aged 64.8 years) met the inclusion criteria. In the majority of cases an acute myocardial infraction was certified during autopsy (92.4%). Grading severity of coronary arteries lesions in most of cases they characterized as severe (75%), and only in two cases they found to be normal. Males were more possible to have moderate or severe lesions in coronary arteries compared with females. Severe atheromatosis was found in older victims more frequent compare to younger. Conclusions: Acute myocardial infarction is a common autopsy finding among victims of sudden cardiac death. Old-aged myocardial infraction also can be identified in many cases and the severity of atheromatic lesions extends by age.

Keywords:

sudden death, coronary artery disease,

PDF

___

1. Margey R, Roy A, Tobin S, O'Keane CJ, McGorrian C, Morris V et al. Sudden cardiac death in 14- to 35-year olds in Ireland from 2005 to 2007: a retrospective registry. Europace. 2011;13:1411-8.
2. Cobb LA, Fahrenbruch CE, Olsufka M, Copass MK. Changing incidence of out-of-hospital ventricular fibrillation, 1980 –2000. JAMA. 2002;288:3008-13.
3. Zheng ZJ, Croft JB, Giles WH, Mensah GA. Sudden cardiac death in the United States, 1989 to 1998. Circulation. 2001;104:2158-63.
4. Deo R, Albert C. Epidemiology and genetics of sudden cardiac death. Circulation. 2012;125:620-37.
5. Fox CS, Evans JC, Larson MG, Kannel WB, Levy D. Temporal trends in coronary heart disease mortality and sudden cardiac death from 1950 to 1999: the Framingham Heart Study. Circulation. 2004;110:522-7.
6. Elliott PM, Anastasakis A, Borger MA, Borggrefe M, Cecchi F, Charron P et al. 2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy: The Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC). Eur Heart J. 2014;35:2733-79.
7. Koutalas E, Kanoupakis E, Vardas P. Sudden cardiac death in non-ischemic dilated cardiomyopathy: a critical appraisal of existing and potential risk stratification tools. Int J Cardiol. 2013;167:335-41.
8. Anderson EL. Arrhythmogenic right ventricular dysplasia. Am Fam Physician. 2006;73:1391-8.
9. Schimpf R, Veltmann C, Wolpert C, Borggrefe M. Arrhythmogenic hereditary syndromes: Brugada Syndrome, long QT syndrome, short QT syndrome and CPVT. Minerva Cardioangiol. 2010;58:623-36.
10. Basso C, Burke M, Fornes P, Gallagher PJ, de Gouveia RH, Sheppard M et al. Guidelines for autopsy investigation of sudden cardiac death. Virchows Arch. 2008;452:11-8.
11. Ladich E, Renu Virmani R, Burke A. Sudden cardiac death not related to coronary atherosclerosis. Toxicol Pathol. 2006;34:52-7.
12. Fishman GI, Chugh S, DiMarco JP, Albert CM, Anderson ME, Bonow RO et al. Sudden cardiac death prediction and prevention report from a National Heart, Lung, and Blood Institute and Heart Rhythm Society workshop. Circulation. 2010;122:2335-48.
13. Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M et al. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/American Heart Association task force and the European Society of Cardiology committee for practice guidelines (writing committee to develop guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death): developed in collaboration with the European Heart Rhythm association and the Heart Rhythm Society. Circulation. 2006;114: 385-484.
14. Adabag AS, Luepker RV, Roger VL, Gersh BJ. Sudden cardiac death: epidemiology and risk factors. Nat Rev Cardiol. 2012;125:620-37.
15. Albert CM, Chae CU, Grodstein F, Rose LM, Rexrode KM, Ruskin JN et al. Prospective study of sudden cardiac death among women in the United States. Circulation. 2003;107:2096-101.
16. Michalodimitrakis M, Mavroforou A, Giannoukas AD. Lessons learnt from the autopsies of 445 cases of sudden cardiac death in adults. Coron Artery Dis. 2005;16:385-9.
17. Arntz HR, Willich SN, Schreiber C, Brüggemann T, Stern R, Schultheiss HP. Diurnal, weekly and seasonal variation of sudden death. Population-based analysis of 24,061 consecutive cases. Eur Heart J. 2000;21:315-20.
18. Myerburg, RJ. Castellanos, A. Cardiac arrest and sudden cardiac death. In Braunwald’s Heart Disease. A Textbook of Cardiovascular Medicine (Eds RO Bonow, DL Mann, DP Zipes, P Libby):845-80. Philadelphia, Elsevier Saunders, 2012.
19. McGill HC Jr, McMahan CA, Herderick EE, Zieske AW, Malcom GT, Tracy RE et al. Obesity accelerates the progression of coronary atherosclerosis in young men. Circulation. 2002;105:2712-8.
20. Kannel WB, Gagnon DR, Cupples LA. Epidemiology of sudden coronary death: population at risk. Can J Cardiol. 1990;6:439-44.
21. Chiuve SE, Rimm EB, Mukamal KJ, Rexrode KM, Stampfer MJ, Manson JE et al. Light-to-moderate alcohol consumption and risk of sudden cardiac death in women. Heart Rhythm. 2010;7:1374-80.
22. McGill HC Jr, McMahan CA, Zieske AW, Tracy RE, Malcom GT, Herderick EE et al. Association of Coronary Heart Disease Risk Factors with microscopic qualities of coronary atherosclerosis in youth. Circulation 2000;102:374-9.
23. Takada A, Saito K, Ro A, Kobayashi M, Hamamatsu A, Murai T et al. Acute coronary syndrome as a cause of sudden death in patients with old myocardial infarction: a pathological analysis. Leg Med (Tokyo). 2003;5:292-4.
24. Farb A, Tang AL, Burke AP, Sessums L, Liang Y, Virmani R. Sudden coronary death. Frequency of active coronary lesions, inactive coronary lesions, and myocardial infarction. Circulation. 1995;92:1701-9.
25. Di Maio VJ, Di Maio DJ. Incidence of coronary thrombosis in sudden death due to coronary artery disease. Am J Forensic Med Pathol. 1993;14:273-5.
26. Davies MJ, Thomas A. Thrombosis and acute coronary-artery lesions in sudden cardiac ischemic death. N Engl J Med. 1984;310:1137-40.
27. Vrints CJM. Spontaneous coronary artery dissection. Heart. 2010;96:801-8.