Retrospective analysis of seasonal and circadian influences on acute changes in atherosclerotic plaques in cases of fatal coronary atherosclerosis

Overview

Introduction: Sudden cardiac death due to coronary atherosclerosis remains the most common cause of sudden cardiac death in the adult population. Cases of sudden death from cardiovascular causes are the most common part of autopsy forensic practice.

Material and methodology: The study included 90 cases of sudden cardiac death caused by acute changes in atherosclerotic plaques, which were retrospectively analyzed with a focus on age, sex, seasonal and circadian influences, risk factors for atherosclerosis, type and location of coronary artery occlusion and the presence of external toxicological substances.

Results: The group consisted of 63 men (70.0%) and 27 women (30.0%). The average age of the deceased was 70.1 years. Most deaths occurred in the afternoon and evening hours (39.8% in total), and the least surprisingly in the morning hours (8.9%). The most common days of death were Thursday and Friday (37.8% in total). In terms of seasons, the most deaths occurred in the winter months (34.4%). In men, the accumulation of multiple risk factors was evident –⁠ 81.0% of men had 4 or more risk factors for atherosclerosis. In women, only 40.7% of women achieved the accumulation of 4 or more risk factors. Coronary artery thrombosis was detected in 55 cases (61.1%), other forms of significant coronary artery occlusion was found in a total of 35 people (38.9%). In terms of localization of the occlusion, the anterior interventricular branch (RIVA) of the left coronary artery was most often affected in both sexes, in a total of 67 people (74.4%). The most common phenomenon was the simultaneous involvement of two coronary arteries (36.7% of cases).

Conclusion: The authors analysed the morphological findings on the coronary arteries in cases of fatal coronary atherosclerosis with special focus on acute changes in atherosclerotic plaques, anamnestic data of the deceased with an emphasis on risk factors for atherosclerosis, and circadian and seasonal influences on the incidence of fatal coronary atherosclerosis. The study confirmed an increased incidence of acute coronary events in the winter period, on working days and in the home in both sexes. An important accompanying phenomenon was the accumulation of risk factors, especially in men. Another follow-up and larger study will be suitable for an exact evaluation of the identified phenomena.

Keywords:

acute coronary syndrome – Autopsy – Circadian rhythms – Atherosclerosis – sudden cardiac death