Precursors of sudden coronary death. Factors related to the incidence of sudden death

Abstract

Precursors of sudden death were sought in men (1838 civil servants in Albany, New York, and 2282 residents of Framingham, Massachusetts) under continuous surveillance for 16 yr. In men 45 to 74 yr old, there were 234 deaths attributed to coronary heart disease (CHD), of which 109 occurred within one hr of onset of symptoms. More than half of all deaths due to CHD occurred outside the hospital, and about 80% of these were sudden. Most were unheralded by prior symptoms of CHD. Persons at high risk of death from CHD, including sudden death, can be identified long before the terminal unexpected catastrophe. The same precursive stigmata exist in persons subject to coronary attacks whether or not immediately fatal. The risk of sudden death in these 2 populations was positively correlated with high blood pressure, the electrocardiographic pattern of left ventricular enlargement, obesity, and heavy cigarette usage. Sudden death is a common and possibly incidental expression of lethal coronary heart disease. The potential candidate for sudden death cannot be confidently distinguished from the individual who succumbs more slowly of myocardial infarction. The inescapable conclusion is that the prevention of sudden death requires the prevention of coronary attacks.