Sudden death in the young. Is acute coronary thrombosis the major precipitating factor?

Corrado, Domenico; Basso, Cristina; Poletti, Angelo; Angelini, Annalisa; Valente, M; Thiene, Gaetano

doi:10.1161/01.cir.90.5.2315

Cited by 125 publications

(48 citation statements)

References 50 publications

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“…17 However, the prevalence of coronary artery disease increases with age, and this condition is the most frequent underlying cause in patients Ͼ30 years of age. 17,18 If parental history of coronary heart disease is a well-known risk factor for coronary heart disease, 12,13 we were unable to find any study that reported data on parental history of sudden death as a specific risk factor for sudden death.…”

Section: Possible Etiologic Pathwaysmentioning

confidence: 94%

Predicting Sudden Death in the Population

et al. 1999

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Background-Sudden death was found to share the same set of usual risk factors as coronary events and therefore could not be specifically predicted in the population. It appears, however, that parental history of sudden death has not been investigated yet as a risk factor for sudden death. Therefore, we assessed risk factors, including parental sudden death, associated with the occurrence of sudden death in a long-term cohort study. Methods and Results-We included 7746 men employed by the city of Paris who were 43 to 52 years of age in 1967 to 1972 in the Paris Prospective Study I. Each subject underwent a physical examination and an ECG, provided blood for laboratory tests, and answered questionnaires administered by trained interviewers who paid particular attention to family medical history. Men with known ischemic cardiac disease were further excluded from analysis. For 95.5% of the men, vital status was obtained from specific inquiries until retirement, then by death certificates. Resting heart rate, systolic or diastolic blood pressure, tobacco consumption, body mass index, diabetes status, serum cholesterol, and parental history of sudden death were independent factors associated with sudden death during follow-up (23 years on average). When adjusted for confounding variables, including parental history of myocardial infarction, relative risk of sudden death associated with parental sudden death was 1.80 (95% CI, 1.11 to 2.88). Conclusions-Parental sudden death is an independent risk factor for sudden death in middle-aged men. The existence of familial risk factors for sudden death may help provide better identification of subjects at high risk of and early prevention of sudden death. (Circulation. 1999;99:1978-1983.)

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Section: Possible Etiologic Pathwaysmentioning

confidence: 94%

Predicting Sudden Death in the Population

et al. 1999

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“…26 The observations noted above illustrate the problems encountered in attempting to predict acute coronary syndromes on the basis of histopathology of atherosclerotic plaques. Furthermore, the pathology of acute coronary syndromes cannot be reduced to the analysis of a localized unstable plaque.…”

Section: Schmermund and Erbelmentioning

confidence: 98%

Unstable Coronary Plaque and Its Relation to Coronary Calcium

2001

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Abstract-Coronary calcium is intimately associated with coronary atherosclerotic plaque development. The use of electron-beam computed tomography (EBCT) for accurate quantitative measurements has led to an increased interest in understanding the clinical importance of coronary calcium, particularly in terms of the ability to identify unstable coronary plaques that underlie the clinical acute coronary syndromes. Histopathologic studies have demonstrated that calcium is a frequent feature of ruptured plaques, but the presence or absence of calcium does not allow for reliable distinction between unstable versus stable plaques. This issue is complicated by the lack of a prospective definition for "unstable." Plaque rupture is sometimes found in apparently healthy subjects and in patients with clinically stable disease. Coronary atherosclerosis is a coronary systemic disease process. Imaging of coronary calcium, although unable to identify a localized unstable plaque, potentially can identify the more clinically pertinent "unstable patient." Almost all patients with a recent acute coronary syndrome have measurable coronary calcium because moderate-to-advanced coronary plaque disease is already present, although obstructive disease frequently is not. Prospective studies have demonstrated that extensive coronary calcium detected by EBCT is associated with a significantly increased incidence of subsequent myocardial infarction, need for revascularization, and coronary death. The incremental prognostic value of coronary calcium compared with that of risk factor assessment remains to be fully defined. The occurrence of an acute coronary syndrome is determined by many factors apart from the extent of atherosclerotic plaque disease. Large prospective trials in the general population are needed to define the subgroups that will benefit most from quantitative assessment of coronary calcium.

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“…17,19,20,22,23,25,26 In Italy, ARVC and premature atherosclerotic coronary artery disease predominate. 24,30,39,40 On the basis of data from the United States, GCVDs account for at least 40% of sudden deaths in young athletes. 17,19,25 Many patients with these conditions aspire to participate in a variety of recreational sporting activities, and some may have even been previously withdrawn from competitive sports in accordance with the recommendations of Bethesda Conference No.…”

Section: Scope Of the Problemmentioning

confidence: 99%

Recommendations for Physical Activity and Recreational Sports Participation for Young Patients With Genetic Cardiovascular Diseases

Maron¹,

Chaitman²,

Ackerman³

et al. 2004

Circulation

501

294

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Abstract-A group of relatively uncommon but important genetic cardiovascular diseases (GCVDs) are associated with increased risk for sudden cardiac death during exercise, including hypertrophic cardiomyopathy, long-QT syndrome, Marfan syndrome, and arrhythmogenic right ventricular cardiomyopathy. These conditions, characterized by diverse phenotypic expression and genetic substrates, account for a substantial proportion of unexpected and usually arrhythmia-based fatal events during adolescence and young adulthood. Guidelines are in place governing eligibility and disqualification criteria for competitive athletes with these GCVDs (eg, Bethesda Conference No. 26 and its update as Bethesda Conference No. 36 in 2005). However, similar systematic recommendations for the much larger population of patients with GCVD who are not trained athletes, but nevertheless wish to participate in any of a variety of recreational physical activities and sports, have not been available. The practicing clinician is frequently confronted with the dilemma of designing noncompetitive exercise programs for athletes with GCVD after disqualification from competition, as well as for those patients with such conditions who do not aspire to organized sports. Indeed, many asymptomatic (or mildly symptomatic) patients with GCVD desire a physically active lifestyle with participation in recreational and leisure-time activities to take advantage of the many documented benefits of exercise. However, to date, no reference document has been available for ascertaining which types of physical activity could be regarded as either prudent or inadvisable in these subgroups of patients. Therefore, given this clear and present need, this American Heart Association consensus document was constituted, based largely on the experience and insights of the expert panel, to offer recommendations governing recreational exercise for patients with known GCVDs.

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Sudden death in the young. Is acute coronary thrombosis the major precipitating factor?

Cited by 125 publications

References 50 publications

Predicting Sudden Death in the Population

Predicting Sudden Death in the Population

Unstable Coronary Plaque and Its Relation to Coronary Calcium

Recommendations for Physical Activity and Recreational Sports Participation for Young Patients With Genetic Cardiovascular Diseases

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