Sex and Racial Differences in Autopsy-Defined Causes of Presumed Sudden Cardiac Death.
Sex and Racial Differences in Autopsy-Defined Causes of Presumed Sudden Cardiac Death.
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DOI：
10.1161/circep.120.009393
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发表时间：
2021-05
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影响因子：
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通讯作者：
Moffatt E
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作者：
Tseng ZH;Ramakrishna S;Salazar JW;Vittinghoff E;Olgin JE;Moffatt E
心脏性猝死(SCD)研究报告男性和黑人发病率较高，但推测是心脏原因。在旧金山县的一项前瞻性尸检研究中，我们试图确定推定SCD发病率和原因的性别和种族差异。所有符合世界卫生组织定义的18-90岁突发事件推定SCD的尸检是通过在心脏猝死后系统调查(POST SCD)研究(2/1/2011-3/1/2014)中对连续的院外死亡进行积极监测而进行的。尸检定义的心律失常猝死(SADS)没有心脏外原因或急性心力衰竭。在541个假定的SCD中，525个(97%)是尸检的；362个(69%)是男性，110个亚洲人(21%)，81个黑人(15%)，40个西班牙裔(8%)，279个白人(53%)和15个其他种族(3%)。经年龄和种族调整后，女性推定为SCD的非心脏原因更多，包括肺血栓(8%比2%)和神经原因(10%比3%，均P<；0.01)。在尸检确定的SAD中，男性的发病率是女性的3倍，而女性有更多的原发电病(4%比2%，p=0.02)和非缺血性原因(53%比39%，p<；0.01)。黑人女性的年龄调整发病率比率高于白人女性(2.55，p<；0.01)，而亚裔和西班牙裔男性(两者均为0.51，p<；0.05)低于白人女性。在亚裔SADS患者中，无冠状动脉梗阻的心肌梗死比白人更常见(7%比1%；调整后p<；0.05)。神经性猝死在亚洲人中更常见，内分泌原因在黑人中更常见，胃肠道原因在西班牙裔比白人更常见(调整后P均0.05)。在这项推定为SCD的全县尸检研究中，女性有更多的非缺血性和非心脏原因。黑人女性的尸检定义的SAD的比例高于白人女性，而亚裔和西班牙裔男性的比例低于白人男性。这些发现对妇女和少数群体中的风险分层和预防猝死具有重要意义。
Sudden cardiac death (SCD) studies report higher incidence in men and Blacks but presume cardiac cause. We sought to identify sex and race differences in rates and causes of presumed SCDs in a prospective postmortem study in San Francisco County. All incident presumed SCDs meeting World Health Organization definition ages 18–90 were autopsied via active surveillance of consecutive out-of-hospital deaths in the POstmortem Systematic InvesTigation of Sudden Cardiac Death (POST SCD) Study (2/1/2011 – 3/1/2014). Autopsy-defined sudden arrhythmic deaths (SADs) had no extra-cardiac cause or acute heart failure. Among 541 presumed SCDs, 525 (97%) were autopsied; 362 (69%) were male, 110 Asian (21%), 81 Black (15%), 40 Hispanic (8%), 279 White (53%), and 15 Other Race (3%). Adjusted for age and race, women had more non-cardiac causes of presumed SCD, including pulmonary emboli (8% vs. 2%) and neurologic causes (10% vs. 3%, both p<0.01). Of autopsy-defined SAD, men had 3-fold higher rates while women had more primary electrical disease (4% vs. 2%, p=0.02) and non-ischemic causes (53% vs. 39%, p<0.01). Age-adjusted incidence rate ratios were higher for Black women (2.55, p<0.01), and lower for Asian and Hispanic men (0.51 for both, p<0.05) than their White counterparts. Myocardial infarction without obstructive coronary arteries was more common among SADs in Asians than Whites (7% vs. 1%; adjusted p<0.05). Sudden neurologic deaths were more common in Asians, endocrine causes more common in Blacks, and gastrointestinal causes more common in Hispanics than Whites (adjusted p all <0.05). In this countywide postmortem study of presumed SCDs, women had more non-ischemic and non-cardiac causes. Black women had higher rates of autopsy-defined SAD than White women while Asian and Hispanic men had lower rates than White men. These findings have implications for risk stratification and prevention of sudden mortality in women and minority populations.