Sudden cardiac death in South India: Incidence, risk factors and pathology

Uma N Srivatsa; K Swaminathan; K Sithy Athiya Munavarah; Ezra Amsterdam; K Shantaraman

doi:10.1016/j.ipej.2016.10.004

Sudden cardiac death in South India: Incidence, risk factors and pathology

Indian Pacing Electrophysiol J. 2016 Jul-Aug;16(4):121-125. doi: 10.1016/j.ipej.2016.10.004. Epub 2016 Oct 22.

Authors

Uma N Srivatsa¹, K Swaminathan², K Sithy Athiya Munavarah², Ezra Amsterdam³, K Shantaraman²

Affiliations

¹ University of California (Davis) Medical Center, Sacramento, CA, United States. Electronic address: unsrivatsa@ucdavis.edu.
² Tirunelveli Medical College, Tirunelveli, India.
³ University of California (Davis) Medical Center, Sacramento, CA, United States.

Abstract

Background: Sudden cardiac death (SCD) is a major cause of mortality secondary to coronary artery disease (CAD) in the industrialized societies. Although South Asians have a high prevalence of CAD, the frequency and underlying pathology of SCD among this population are unknown.

Methods: Medical records of consecutive patients presenting with unexplained sudden death (USD) in a tertiary care center were reviewed. Patients with trauma, violent deaths, positive toxicology and non-cardiac pathology were excluded to determine sudden cardiac death (SCD). Cardiac pathological findings were analyzed by autopsy. SCD rate was estimated based on census and government vital statistics for the years studied.

Results: During a two year period, 223 patients (mean age 55 + 10 yrs, 78.9% male, body mass index 26 + 4, 60% smokers, 39% known CAD, 46% hypertension, 43% diabetes) presented to hospital with USD. SCD was attributed to myocardial infarction (MI) in 87% of cases; 69% were acute (96% anterior MI); 76% were small/moderate infarct and 9.9% of the cohort had normal hearts. Based on official municipal vital statistics, the SCD rate in those >35 yrs of age was estimated as 39.7/100,000 with male/female ratio of 4.6.

Conclusions: SCD in this south Indian city occurred predominantly in men of relatively young age and was most frequently associated with small or moderate-sized acute MI. Improved health care access, preventive measures and enhanced emergency management may reduce SCD from acute MI in this locale.

Keywords: Autopsy; Risk factors; South India; Sudden cardiac death.