Thirty-five of 40 young men whose deaths were caused by coronary heart disease died suddenly (less than 24 hours after onset of terminal symptoms). Many had myocardial necrosis or scars consistent with ischemic episodes that occurred hours, days, or months prior to death, yet 94% did not reach a hospital or receive medical care during the terminal episode. These results are from an investigation of 579 men, aged 25 to 44 years, who lived, died, and were autopsied in Orleans Parish, Louisiana. Among those who died of coronary heart disease, the vast majority had extensive advanced atherosclerotic lesions in the coronary arteries irrespective of suddenness of death. The frequent occurrence of gross scars indicative of healed myocardial infarction among young men, both black and white, who died suddenly of coronary heart disease may offer new hope that improved case finding might identify persons who could benefit from vigorous programs of early intervention.