Análisis de prevalencia de la mortalidad atribuible a causas conocidas de muerte súbita en Chile, población de 1 a 35 años, 2000-2010

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Abstract

Antecedentes: Pocas situaciones son más devastadoras que los casos de pacientes, sin patología previa diagnosticada, que presentan muerte súbita (MS), especialmente durante la práctica deportiva. La mayor parte de las MS son consecuencia de una patología cardíaca subyacente no diagnosticada, definida como muerte súbita cardíaca (MSC). En Chile no existen reportes que analicen la epidemiología de la MSC. La literatura Internacional describe la relación entre patologías cardíacas bien definidas y ejercicio competitivo como gatillante de la MSC. Objetivo: Caracterizar la prevalencia de patologías cardíacas y sus subtipos reconocidos como causas de MSC en el grupo etario de 1 año a 35 años. Métodos: Se analizaron los registros del Departamento de Estadísticas e Información del Ministerio de Salud y los certificados de defunción de todos los fallecidos entre los años 2000-2010 del grupo etario de 1 año a 35 años. Se seleccionaron datos de los fallecidos con diagnósticos relacionados con MSC de acuerdo al Código Internacional de Enfermedades (CIE-10). Resultados: de un total de 57.979 fallecidos, 1131 (1,95%) correspondieron a los códigos del CIE-10 que se estimaron como catalogables dentro de causas de MSC. Las patologías certificadas más frecuentes fueron la enfermedad cardíaca isquémica 43% y las miocar-diopatías 27%. Conclusiones: Este estudio es un primer paso en la caracterización de la MSC en Chile. Los resultados obtenidos demuestran que la enfermedad cardíaca isquémica y las miocardiopatías son las patologías descritas con mayor frecuencia como causa de defunción de MSC en niños y adultos jóvenes, lo que es consistente con la literatura internacional.

Translated abstract

Abstract:There are few events more devastating than Sudden Cardiac Death (SCD) in people without previously known heart disease, especially when occurring during the practice of sports. In Chile we have no reports on SCD epidemiology. Aim: to describe the incidence of SCD and the underlying pathology in people from 1 to 35 years of age. Methods: We searched the registries from the Department of Statistics and Information of the Ministry of Health (DEIS) and analyzed death certificates from all deaths occurring from 2000 to 2010 in people 1 to 35 years of age. Diagnoses deemed to correspond to SCD were those defined by the ICD-10 codes. Results: Out of 57979 deaths, 1131 (1.95%) matched the ICD-10 codes estimated as causes of SCD. Ischemic heart disease (43%) and cardiomyopathies (27%) were the most frequently certified diagnoses. Conclusion: This study is a first step in the characterization of SCD in Chile. The results obtained show that ischemic heart disease and cardiomyopathies are the most frequently described causes of SCD in children and young adults, which is consistent with international reports.

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Most cited references 26

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Sudden death in young competitive athletes. Clinical, demographic, and pathological profiles.

B J Maron, J Shirani, L C Poliac … (1996)

To develop clinical, demographic, and pathological profiles of young competitive athletes who died suddenly. Systematic evaluation of clinical information and circumstances associated with sudden deaths; interviews with family members, witnesses, and coaches; and analyses of postmortem anatomic, microscopic, and toxicologic data. A total of 158 sudden deaths that occurred in trained athletes throughout the United States from 1985 through 1995 were analyzed. MAIN OUTCOME MEASURES--Characteristics and probable cause of death. Of 158 sudden deaths among athletes, 24 (15%) were explained by noncardiovascular causes. Among the 134 athletes who had cardiovascular causes of sudden death, the median age was 17 years (range, 12-40 years), 120 (90%) were male, 70 (52%) were white, and 59 (44%) were black. The most common competitive sports involved were basketball (47 cases) and football (45 cases), together accounting for 68% of sudden deaths. A total of 121 athletes (90%) collapsed during or immediately after a training session (78 cases) or a formal athletic contest (43 cases), with 80 deaths (63%) occurring between 3 PM and 9 PM. The most common structural cardiovascular diseases identified at autopsy as the primary cause of death were hypertrophic cardiomyopathy (48 athletes [36%]), which was disproportionately prevalent in black athletes compared with white athletes (48% vs 26% of deaths; P = .01), and malformations involving anomalous coronary artery origin (17 athletes [13%]). Of 115 athletes who had a standard preparticipation medical evaluation, only 4 (3%) were suspected of having cardiovascular disease, and the cardiovascular abnormality responsible for sudden death was correctly identified in only 1 athlete (0.9%). Sudden death in young competitive athletes usually is precipitated by physical activity and may be due to a heterogeneous spectrum of cardiovascular disease, most commonly hypertrophic cardiomyopathy. Preparticipation screening appeared to be of limited value in identification of underlying cardiovascular abnormalities.

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Nationwide study of sudden cardiac death in persons aged 1-35 years.

Jacob Hansen, Jonas Thomsen, Bo Gregers Winkel … (2011)

The aim of this investigation was to study the incidence of sudden cardiac death (SCD) in persons aged 1-35 years in a nationwide setting (5.38 million people) by systematic evaluation of all deaths. All deaths in persons aged 1-35 years in Denmark in 2000-06 were included. Death certificates were read independently by two physicians. The National Patient Registry was used to retrieve information on prior medical history. All autopsy reports were read and the cause of death was revised based on autopsy findings. We identified 625 cases of sudden unexpected death (10% of all deaths), of which 156 (25%) were not autopsied. Of the 469 autopsied cases, 314 (67%) were SCD. The most common cardiac cause of death was ischaemic heart disease (13%); 29% of autopsied sudden unexpected death cases were unexplained. In 45% of SCD cases, the death was witnessed; 34% died during sleep; 89% were out-of-hospital deaths. Highest possible incidence rate of SCD in the young was 2.8 per 100 000 person-years including non-autopsied cases of sudden unexpected death. Excluding those, the incidence rate declined to 1.9 per 100 000 person-years. A total of 7% of all deaths in the young can be attributed to SCD, when including non-autopsied cases (autopsy ratio 75%). The incidence rate of SCD in the young of 2.8 per 100 000 person-years is higher than previously reported.

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Clinical profile of congenital coronary artery anomalies with origin from the wrong aortic sinus leading to sudden death in young competitive athletes.

Cristina Basso, Barry J Maron, Domenico Corrado … (2000)

The purpose of this study is to characterize the clinical profile and identify clinical markers that would enable the detection during life of anomalous coronary artery origin from the wrong aortic sinus (with course between the aorta and pulmonary trunk) in young competitive athletes. Congenital coronary artery anomalies are not uncommonly associated with sudden death in young athletes, the catastrophic event probably provoked by myocardial ischemia. Such coronary anomalies are rarely identified during life, often because of insufficient clinical suspicion. However, since anomalous coronary artery origin is amenable to surgical treatment, timely clinical identification is crucial. Because of the paucity of available data characterizing the clinical profile of wrong sinus coronary artery malformations, we reviewed two large registries comprised of young competitive athletes who died suddenly, assembled consecutively in the U.S. and Italy. We reported 27 sudden deaths in young athletes, identified solely at autopsy and due to either left main coronary artery from the right aortic sinus (n = 23) or right coronary artery from the left sinus (n = 4). Each athlete died either during (n = 25) or immediately after (n = 2) intense exertion on the athletic field. Fifteen athletes (55%) had no clinical cardiovascular manifestations or testing during life. However, in the remaining 12 athletes (45%) aged 16 +/- 7, certain clinical data were available. Premonitory symptoms had occurred in 10, including syncope in four (exertional in three and recurrent in two, 3 to 24 months before death) and chest pain in five (exertional in three, all single episodes, < or =24 months before death). All cardiovascular tests were within normal limits, including 12-lead electrocardiogram (ECG) pattern (in 9/9), stress ECG with maximal exercise (in 6/6) and left ventricular wall motion and cardiac dimensions by two-dimensional echocardiography (in 2/2). With regard to congenital coronary artery anomalies of wrong aortic sinus origin in young competitive athletes, 1) standard testing with ECG under resting or exercise conditions is unlikely to provide clinical evidence of myocardial ischemia and would not be reliable as screening tests in large athletic populations, 2) premonitory cardiac symptoms not uncommonly occurred shortly before sudden death (typically associated with anomalous left main coronary artery), suggesting that a history of exertional syncope or chest pain requires exclusion of this anomaly. These observations have important implications for the preparticipation screening of competitive athletes.

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Author and article information

Journal

Journal ID (publisher-id): rchcardiol

Title: Revista chilena de cardiología

Abbreviated Title: Rev Chil Cardiol

Publisher: Sociedad Chilena de Cardiología y Cirugía Cardiovascular (Santiago, , Chile )

ISSN (Electronic): 0718-8560

Publication date (Print and electronic): 2013

Volume: 32

Issue: 2

Pages: 117-122

Affiliations

[02] orgnamePontifica Universidad Católica de Chile orgdiv1Facultad de Medicina Chile

[04] orgnamePontificia Universidad Católica orgdiv1División de Pediatría Chile

[01] orgnamePontificia Universidad Católica de Chile orgdiv1Equipo Medicina Deportiva UC Chile

[03] orgnameMinisterio de Salud orgdiv1Departamento de Estadísticas e Información en Salud Chile

Article

Publisher ID: S0718-85602013000200005 Publisher ID: S0718-8560(13)03200200005

DOI: 10.4067/S0718-85602013000200005

SO-VID: d0777040-faf6-497c-9539-fe53fc80d35e

License:

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

History

Date received : 03 May 2013

Date accepted : 03 June 2013

Page count

Figures: 0, Tables: 0, Equations: 0, References: 16, Pages: 6

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SciELO Chile

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Análisis de prevalencia de la mortalidad atribuible a causas conocidas de muerte súbita en Chile, población de 1 a 35 años, 2000-2010 Translated title: Causes of sudden death in subjects 1 to 35 years of age in Chile

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