Key result
Positive post-mortem toxicology in young sudden cardiac death victims was associated with a higher rate of sudden arrhythmic death syndrome compared to negative toxicology (56% vs. 42%, P<0.01).
Why the study?
Does positive toxicology associate with a higher rate of sudden arrhythmic death syndrome in young sudden cardiac death victims?
Cohort (n=620)
Yes
Does positive toxicology associate with a higher rate of sudden arrhythmic death syndrome in young sudden cardiac death victims?
Absolute Event Rate: 56% vs 42%
p-value: p=<0.01
More than half of young sudden cardiac death victims have positive post-mortem toxicology, which is associated with a higher rate of sudden arrhythmic death syndrome, suggesting a potential proarrhythmic role of these compounds.
May inform post-mortem protocols for young SCD; extends observational data but leaves causal role of substances open.
Aims: Several drugs increase the risk of ventricular fibrillation and sudden cardiac death (SCD). We aimed to investigate in detail the toxicological findings of all young SCD throughout Denmark. Methods and results: Deaths in persons aged 1-49 years were included over a 10-year period. Death certificates and autopsy reports were retrieved and read to identify cases of sudden death and establish cause of death. All medico-legal autopsied SCD were included and toxicological reports collected. Positive toxicology was defined as the presence of any substance (licit and/or illicit). All toxicological findings had previously been evaluated not to have caused the death (i.e. lethal concentrations were excluded). We identified 620 medico-legal autopsied cases of SCD, of which 77% (n = 477) were toxicologically investigated post-mortem, and 57% (n = 270) had a positive toxicology profile. Sudden cardiac death with positive toxicology had higher rates of sudden arrhythmic death syndrome (SADS), compared with SCD with negative toxicology (56% vs. 42%, P < 0.01). In total, 752 agents were detected, and polypharmacy (defined as the presence of more than one drug) was present in 61% (n = 164), all substances combined. Psychotropic drugs were the most frequent (62%, n = 467), and 82% (n = 385) were in pharmacological or subpharmacological levels. Conclusion: We found that more than half of all toxicologically investigated SCD victims have positive post-mortem toxicological findings, and polypharmacy is displayed in a considerable proportion. SCD with positive toxicology had higher rate of SADS, suggesting that the compounds may play a proarrhythmic role in these cases.
No takes yet. Share an insight, caveat, or question.
Bjune et al. (2017) conducted a cohort in Sudden cardiac death (n=620). Positive toxicology vs. Negative toxicology was evaluated on Sudden arrhythmic death syndrome (SADS) (p=<0.01). Positive post-mortem toxicology in young sudden cardiac death victims was associated with a higher rate of sudden arrhythmic death syndrome compared to negative toxicology (56% vs. 42%, P<0.01).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: