Abstract
Sixteen prehospital sudden death patients, 3,509 admitted patients and 2,449 longterm follow-up patients after angiographic studies were reviewed. Sudden death was defined as death occurring within 24 hours of being ambulatory, stable and well.
The long-term follow-up of survivors of prehospital sudden death was extremely poor. Half of these patients had underlying coronary artery disease. The survivors were younger and showed more ventricular fibrillation on electrocardiographic recording when arriving at the emergency ward than the dead. Twenty-four patients died a sudden death during admission, 15 of them from acute myocardial infarction. The three leading causes of sudden cardiac death were ventricular fibrillation, cardiogenic shock and cardiac repture, in that order. Sixty-six patients died a sudden cardiac death during long-term follow-up for periods of up to nine years after angiographic studies. Coronary artery disease was the main cause (55%). The majority of these patients had history of old myocardial infarction (78%), especially anterior wall involvement (75%) and multiple coronary risk factors (83%). The common coronary arteriographic findings in most of them had been the presence of proximal left anterior descending artery disease (81%); multivessel including left main trunk disease (70%); proximal sites disease (77%); advanced atherosclerosis with poor collateral circulation (83%) and far more severe abnormalities of left ventricular contraction (70%). Sudden cardiac death could also be predicted by the severity and anatomic sites of coronary artery disease.
Thirteen patients (20%) died a sudden cardiac death due to valvular heart disease, mainly aortic valvular disease. Five patients with dilated cardiomyopathy and one with hypertrophic cardiomyopathy died suddenly. All of them had advanced grades of ventricular arrhythmias. Sudden cardiac death in congenital heart disease, such as tetralogy of Fallot seemed to be caused by the fact that the patients missed the chance for surgical repair Most of the sudden deaths in disease of the great vessels were due to ruptured aneurysm, and all but one was associated with hypertension.
