European journal of preventive cardiology · 2026
Minimal extra-cardiac atherosclerosis present in young people with sudden cardiac death due to coronary artery disease.
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Paratz Elizabeth D, Fahy Louise, Nehme Ziad, Pflaumer Andreas, Stub Dion, La Gerche Andre
Аннотация
AIMS: This study aims to define the association between severe coronary artery disease and widespread atherosclerosis in younger individuals.
METHODS AND RESULTS: Individuals aged 1-50 years with sudden cardiac death (SCD) from 2019 to 2023, autopsy-proven to be due to coronary artery disease, were identified using the state-wide End Unexplained Cardiac Death (EndUCD) registry. Presence of extra-coronary atherosclerosis greater than modified American Heart Association Class III was assessed in four arterial beds (aorta, carotid, renal, and femoral arteries). A total of 3044 individuals experienced SCD; 356 were due to coronary artery disease, and 62 (17.4%) had extra-coronary plaque. Plaque was identified in the aorta (n = 61 patients, 17.1%), carotid arteries (n = 9, 2.5%), iliofemoral arteries (n = 11, 3.1%), and renal arteries (n = 6 patients, 1.7%). Features associated with extra-coronary plaque were older age (median 47.8 vs. 44.4 years, P = 0.0002) and hypertension (30.7 vs. 18.7%, P = 0.035). Patients with extra-coronary plaque had higher rates of cardiomegaly (67.9 vs. 50.7%, P = 0.019), cardiac fibrosis indicative of previous myocardial infarction (46.8 vs. 31.0%, P = 0.017), and multi-vessel coronary disease (71.7 vs. 55.9%, P = 0.024).
CONCLUSION: Fewer than one in five people aged 1-50 years experiencing SCD from a coronary cause exhibited extra-coronary plaque, suggesting that in young people, severe atherosclerosis is not necessarily a concurrent systemic disease. This may limit the utility of screening for carotid or aortic plaque to predict coronary atherosclerosis on an individual level. Individuals with extra-coronary plaque were older with more established coronary disease.
METHODS AND RESULTS: Individuals aged 1-50 years with sudden cardiac death (SCD) from 2019 to 2023, autopsy-proven to be due to coronary artery disease, were identified using the state-wide End Unexplained Cardiac Death (EndUCD) registry. Presence of extra-coronary atherosclerosis greater than modified American Heart Association Class III was assessed in four arterial beds (aorta, carotid, renal, and femoral arteries). A total of 3044 individuals experienced SCD; 356 were due to coronary artery disease, and 62 (17.4%) had extra-coronary plaque. Plaque was identified in the aorta (n = 61 patients, 17.1%), carotid arteries (n = 9, 2.5%), iliofemoral arteries (n = 11, 3.1%), and renal arteries (n = 6 patients, 1.7%). Features associated with extra-coronary plaque were older age (median 47.8 vs. 44.4 years, P = 0.0002) and hypertension (30.7 vs. 18.7%, P = 0.035). Patients with extra-coronary plaque had higher rates of cardiomegaly (67.9 vs. 50.7%, P = 0.019), cardiac fibrosis indicative of previous myocardial infarction (46.8 vs. 31.0%, P = 0.017), and multi-vessel coronary disease (71.7 vs. 55.9%, P = 0.024).
CONCLUSION: Fewer than one in five people aged 1-50 years experiencing SCD from a coronary cause exhibited extra-coronary plaque, suggesting that in young people, severe atherosclerosis is not necessarily a concurrent systemic disease. This may limit the utility of screening for carotid or aortic plaque to predict coronary atherosclerosis on an individual level. Individuals with extra-coronary plaque were older with more established coronary disease.