Minimal extra-cardiac atherosclerosis present in young people with sudden cardiac death due to coronary artery disease.

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 EndUCD registry. The presence of extra-coronary atherosclerosis greater than modified American Heart Association Class III was assessed in five arterial beds (intra-cerebral vessels, aorta, and carotid, renal, and femoral arteries). A total of 3044 individuals experienced SCD; 356 were due to coronary artery disease and 64 (18.0%) had extra-coronary plaque. Plaque was identified in aorta (61/356 patients, 17.1%), carotid arteries (9/356, 2.5%), iliofemoral arteries (11/356, 3.1%), intracerebral arteries (4/153, 2.6%), and renal arteries (6/356 patients, 1.7%). The only feature associated with extra-coronary plaque was older age (median 47.8 vs. 44.4 years, P = 0.0002). Patients with extra-coronary plaque had higher rates of cardiomegaly (67.2% vs. 50.7%, P = 0.022), cardiac fibrosis indicative of previous myocardial infarction (45.3% vs. 31.2%, P = 0.030), and multi-vessel coronary disease (72.6% vs. 55.6%, P = 0.014).

CONCLUSION

Fewer than one in five people aged 1-50 years experiencing SCD from a coronary cause exhibit extra-coronary plaque, suggesting that in young people, severe atherosclerosis is not necessarily a systemic disease. This limits 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.