Clinical characteristics of aortic aneurysm and dissection as a cause of sudden death in outpatients.

OBJECTIVE

To describe characteristics of nonhospitalized patients experiencing sudden death from aortic causes and compare with characteristics of patients experiencing nontraumatic, unexpected, outpatient death from other causes.

METHODS

Retrospective case-control analysis of patients aged 18 to 65 years with nontraumatic, unexpected, outpatient cardiac arrest, emergency department (ED) resuscitation attempts, and autopsy-determined cause of death. Demographics, prodromal symptoms, and arrest characteristics were examined, and univariate comparisons between patients with aortic and those with nonaortic causes of death were performed.

RESULTS

A total of 384 patients met inclusion criteria. Aortic pathology represented 4.4% of patients (12 dissections, 5 aneurysms). Preexisting aortic disease (n = 2) and antemortem suspicion of an aortic cause (n = 3) were uncommon. Patients with an aortic cause of death often had prodromal symptoms (53% 95% CI; 28%-77%) and hemopericardium (47% 95% CI; 23%-72%), were older, and were more likely to have a pulse in the ED, an arrest rhythm of pulseless electrical activity, and an arrest witnessed arrest by a medical provider.

CONCLUSION

In this sample of outpatients with cardiac arrest from aortic disease, death was not instantaneous, and hemopericardium was common in many patients with dissection.