Indian Study Finds Advanced Coronary Atherosclerosis in Over Half of Sudden Cardiac Death Cases
India: A recent study has revealed that integrating histological grading with quantitative morphometric analysis is the essential key to unmasking the true severity of atherosclerosis-related myocardial damage, a vital discovery given that Ischaemic Heart Disease (IHD) was identified in 54.6% of sudden death autopsies.
Sudden cardiac death remains a major public health challenge, often occurring without preceding symptoms. Atherosclerosis, the dominant pathological substrate in such deaths, may not be fully characterized through histological grading alone. To address this gap, researchers Prathana Patel, Smita Jhaveri, and Parth Patel from the Department of Pathology, SMIMER Medical College, Surat, conducted a detailed evaluation of coronary and myocardial changes using both histological and morphometric parameters.
The 18-month observational study analyzed 194 autopsy cases of natural sudden deaths, excluding non-natural causes and autolyzed specimens. Coronary arteries were examined using the modified Virchow’s method and graded according to the American Heart Association (AHA) classification. Quantitative assessment of arterial narrowing was performed using the intimal thickness index (ITI) and intima-to-media ratio (IMR), alongside histological documentation of myocardial changes.
- High Prevalence of IHD: The study suggests that IHD is the most dominant myocardial pathology identified, accounting for 54.6% of the 194 sudden death autopsy cases.
- Widespread Multi-vessel Disease: Among individuals diagnosed with IHD, a significant 76% exhibited atherosclerotic involvement in both major coronary arteries.
- Predominance of Advanced AHA Grading: Severe coronary pathology was prevalent in IHD cases, with AHA Grade VII (47.2%) and Grade V (21.7%) representing the most common classifications.
- Regional Arterial Susceptibility: Clinically, atherosclerosis was notably more frequent in the Left Coronary Artery (LCA) at 33.5% compared to the Right Coronary Artery (RCA) at 15.4%.
- Elevated Morphometric Indicators: Myocardial damage strongly correlated with increased quantitative markers, as IHD cases demonstrated an average ITI of 2.3 ± 0.8 and an IMR of 4.3 ± 2.2
The findings higlight that integrating histological grading with morphometric indices such as ITI and IMR allows for a more precise characterization of atherosclerosis-related myocardial damage in sudden death cases. The authors emphasize that relying on histology alone may underestimate disease severity, particularly in advanced coronary involvement.
The study adds important pathological insight into the structural basis of sudden cardiac death and highlights the value of combined qualitative and quantitative assessment in autopsy-based cardiovascular research.
Patel P, Jhaveri S, Patel P. Histological and Morphometric Analysis with Grading of Atherosclerosis-Associated Myocardial Changes in Cases of Sudden Death at a Tertiary Care Hospital. Natl J Med Res 2025;15(03):202-208. DOI: 10.55489/njmr.150320251125.
