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- Title
Can post-mortem coronary artery calcium scores aid diagnosis in young sudden death?
- Authors
Paratz, Elizabeth D.; Costello, Ben; Rowsell, Luke; Morgan, Natalie; Smith, Karen; Thompson, Tina; Semsarian, Chris; Pflaumer, Andreas; James, Paul; Stub, Dion; La Gerche, André; Zentner, Dominica; Parsons, Sarah
- Abstract
This study sought to explore the feasibility and utility of post-mortem coronary artery calcium (CAC) scoring in identifying patients with ischemic heart disease as cause of sudden death. 100 deceased patients aged 18–50 years underwent post-mortem examination in the setting of sudden death. At post-mortem, fifty cases were determined to have ischemic heart disease, and fifty had death attributed to trauma or unascertained causes. The CAC score was calculated in a blinded manner from post-mortem CTs performed on all cases. CAC scores were assessable in 97 non-decomposed cases (feasibility 97%). The median CAC score was 88 Agatston units [IQR 0–286] in patients deceased from ischemic heart disease vs 0 [IQR 0–0] in patients deceased from other causes (p < 0.0001). Presence of any coronary calcification differed significantly between ischemic heart disease and non-ischemic groups (adjusted odds ratio 10.7, 95% CI 3.2—35.5). All cases with a CAC score > 100 (n = 22) had ischemic heart disease as the cause of death. Fifteen cases had a CAC score of zero but severe coronary disease at post-mortem examination. Post-mortem CAC scoring is highly feasible. An elevated CAC score in cases 18–50 years old with sudden death predicts ischemic heart disease at post-mortem examination. However, a CAC score of zero does not exclude significant coronary artery disease. Post-mortem CAC score may be considered as a further assessment tool to help predict likely cause of death when there is an objection to or unavailability of post-mortem examination.
- Subjects
SUDDEN death; DIAGNOSIS; CORONARY arteries; CORONARY disease; AUTOPSY; ISCHEMIC preconditioning
- Publication
Forensic Science, Medicine & Pathology, 2021, Vol 17, Issue 1, p27
- ISSN
1547-769X
- Publication type
Article
- DOI
10.1007/s12024-020-00335-z