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Invited Commentary
July 10, 2019

Frequency of Left Ventricular Scars at Autopsy in Persons Dying Suddenly of Coronary Artery Disease With or Without Earlier Myocardial Infarction

Author Affiliations
  • 1Baylor Scott & White Heart and Vascular Institute, Dallas, Texas
  • 2Division of Cardiology, Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas
JAMA Cardiol. 2019;4(8):802-803. doi:10.1001/jamacardio.2019.2238

In this issue of JAMA Cardiology, Vähätalo et al1 investigated through clinical and autopsy records 5869 persons who had died suddenly of nontraumatic causes in northern Finland during a recent 20-year period. The deaths of 4392 individuals (74.8%) were attributed to coronary artery disease (CAD) and the deaths of 1477 individuals (25.2%) to non-CAD conditions. Of the 4392 individuals who died of CAD, 3122 (71.1%) had no prior diagnosis of CAD, per the authors, and 1026 (23.4%) had a prior CAD diagnosis. Of the 3122 with no prior CAD diagnosis, 1322 individuals (42.4%) had a left ventricular (LV) scar at autopsy, and 1798 (57.6%) did not. The article compares clinical and cardiac morphologic findings in those with vs those without an LV scar at autopsy. The scars, of course, indicate that those individuals had had an acute myocardial infarction (MI) that had healed: in 42.4%, the acute MI apparently was not recognized during life (which is called a silent MI). There were no significant differences between the 2 groups in frequency of diabetes mellitus (249 of 1322 [18.8%] vs 312 of 1798 [17.4%]), systemic hypertension (523 [39.6%] vs 688 [38.3%]), dyslipidemia (149 [11.3%] vs 200 [11.1%]), angina pectoris (81 [6.1%] vs 104 [5.8%]), or dyspnea (45 [3.4%] vs 53 [2.9%]). There were statistically different but not clinically meaningful differences between those with vs those without LV scars in mean (SD) age (66.9 [11.1] years vs 65.5 [11.6] years; P= .001) and heart weight (mean [SD]: men, 497.2 [107.0] g vs 454.7 [105.0] g; P < .001; women, 411.3 [85.7] g vs 386.1 [91.2] g; P = .001) and frequencies of total occlusion of a coronary artery (519 of 1322 [39.3%] vs 291 of 1798 [16.2%]; P < .001), occurrence of sudden death during physical activity (241 of 1322 [18.2%] vs 223 of 1798 [12.4%]; P < .001), and occurrence of the sudden death event outside (265 of 1322 [20.0%] vs 268 of 1798 [14.9%]; P = .001).

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