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Can post-mortem coronary artery calcium scores aid diagnosis in young sudden death?

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Abstract

This study sought to explore the feasibility and utility of post-mortem coronary artery calcium (CAC) scoring in identifying patients with ischemic heart disease as cause of sudden death. 100 deceased patients aged 18–50 years underwent post-mortem examination in the setting of sudden death. At post-mortem, fifty cases were determined to have ischemic heart disease, and fifty had death attributed to trauma or unascertained causes. The CAC score was calculated in a blinded manner from post-mortem CTs performed on all cases. CAC scores were assessable in 97 non-decomposed cases (feasibility 97%). The median CAC score was 88 Agatston units [IQR 0–286] in patients deceased from ischemic heart disease vs 0 [IQR 0–0] in patients deceased from other causes (p < 0.0001). Presence of any coronary calcification differed significantly between ischemic heart disease and non-ischemic groups (adjusted odds ratio 10.7, 95% CI 3.2—35.5). All cases with a CAC score > 100 (n = 22) had ischemic heart disease as the cause of death. Fifteen cases had a CAC score of zero but severe coronary disease at post-mortem examination. Post-mortem CAC scoring is highly feasible. An elevated CAC score in cases 18–50 years old with sudden death predicts ischemic heart disease at post-mortem examination. However, a CAC score of zero does not exclude significant coronary artery disease. Post-mortem CAC score may be considered as a further assessment tool to help predict likely cause of death when there is an objection to or unavailability of post-mortem examination.

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Funding

This project was not directly funded. EDP is supported by a NHMRC/NHF co-funded Postgraduate Scholarship (APP 1168218), RACP JJ Billings Scholarship and PSA Cardiovascular Scholarship. ALG is supported by a NHF Future Leader Fellowship. DS is supported by a NHF Future Leader Fellowship and Viertel Foundation Grant. CS is supported by a NHMRC Australia Practitioner Fellowship. The EndUCD registry is supported by the Ross Dennerstein Foundation.

Author information

Author notes

  1. Dominica Zentner and Sarah Parsons shared senior authorship.

Authors and Affiliations

  1. Baker Heart and Diabetes Institute, 75 Commercial Rd, Prahran, VIC, 3181, Australia

    Elizabeth D. Paratz, Ben Costello, Luke Rowsell, Dion Stub & André La Gerche

  2. Alfred Hospital, 55 Commercial Rd, Prahran, VIC, 3181, Australia

    Elizabeth D. Paratz, Dion Stub & André La Gerche

  3. St Vincent’s Hospital Melbourne, 41 Victoria Pde, Fitzroy, VIC, 3065, Australia

    Elizabeth D. Paratz, Ben Costello & André La Gerche

  4. Victorian Institute of Forensic Medicine, 65 Kavanagh St, Southbank, VIC, 3006, Australia

    Natalie Morgan & Sarah Parsons

  5. Ambulance Victoria, 375 Manningham Rd, Doncaster, VIC, 3108, Australia

    Karen Smith

  6. Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne, VIC, Australia

    Karen Smith

  7. Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC, 3050, Australia

    Tina Thompson & Dominica Zentner

  8. Centenary Institute and The University of Sydney, Missenden Rd, Sydney, NSW, 2050, Australia

    Chris Semsarian

  9. Royal Children’s Hospital, 50 Flemington Rd, Parkville Melbourne, VIC, 3052, Australia

    Andreas Pflaumer

  10. Department of Paediatrics, Melbourne University, Parkville, VIC, 3010, Australia

    Andreas Pflaumer

  11. Murdoch Children’s Research Institute, Royal Children’s Hospital, Flemington Rd, Parkville, VIC, 3052, Australia

    Karen Smith & Andreas Pflaumer

  12. Peter MacCallum Cancer Centre, 305 Grattan St, Parkville, VIC, 3050, Australia

    Paul James

  13. Department of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, 3004, Australia

    Dion Stub

  14. Department of Forensic Medicine, Monash University, 65 Kavanagh St, Southbank, VIC, 3006, Australia

    Sarah Parsons

  15. Royal Melbourne Hospital Clinical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, 3000, Australia

    Dominica Zentner

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  1. Elizabeth D. Paratz
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  2. Ben Costello
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Contributions

All authors contributed to the article design, analysis and write-up. All authors have confirmed that they are happy for publication of the article.

Corresponding author

Correspondence to Elizabeth D. Paratz.

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No conflict of interest has been identified.

Ethical approval

This study complies with the ethical principles of the Declaration of Helsinki. Ethical approval was granted by the institutional ethics committee (approval number 03/2018).

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All authors have confirmed that they are happy for publication of the article. The Victorian Institute of Forensic Medicine has provided written confirmation of permission to publish the material.

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Paratz, E.D., Costello, B., Rowsell, L. et al. Can post-mortem coronary artery calcium scores aid diagnosis in young sudden death?. Forensic Sci Med Pathol 17, 27–35 (2021). https://doi.org/10.1007/s12024-020-00335-z

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  • DOI: https://doi.org/10.1007/s12024-020-00335-z

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