Non-atherosclerotic coronary artery disease and sudden death in the young

Abstract

Objective-To assess prevalence and type of non-atherosclerotic coronary artery disease in young people (≤35 years) who died suddenly. Design-A necropsy study of 150 consecutive cases of sudden death (that is, within 6 h of the onset of symptoms). Results-Death was attributed to coronary artery disease in 48 cases: in 16 (33%) of them the disease was nonatherosclerotic. Twelve subjects (eight males and four females, age range 2-35 years, mean 242) had congenital anomalies: a deep intramyocardial course in six, origin from the wrong sinus in three, and ostial obstructions in three. Sudden death was the first manifestation of disease in six cases. The other six had a history of palpitation or syncope or both. An electrocardiogram was available in five cases and showed ventricular arrhythmias in four; none had angina pectoris. Stress testing was available in two cases: neither showed any effortdependent ST-T abnormalities. In six cases sudden death was related to physical exercise. Acquired nonatherosclerotic coronary artery disease was found in four cases: spontaneous coronary dissection in three previously symptom free patients and Kawasaki coronary arteritis in one child who had had acute myocardial infarction. Conclusion-One third of the cases of fatal coronary artery disease were nonatherosclerotic with coronary artery anomalies being the most frequent form. Coronary artery anomalies should be suspected in young patients who have symptoms of ventricular arrhythmias without any overt signs and symptoms of ischaemia.