Can post-mortem coronary artery calcium scores aid diagnosis in young sudden death?

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ORIGINAL ARTICLE

Can post‑mortem coronary artery calcium scores aid diagnosis in young sudden death? Elizabeth D. Paratz1,2,3   · Ben Costello1,3 · Luke Rowsell1 · Natalie Morgan4 · Karen Smith5,6,11 · Tina Thompson7 · Chris Semsarian8 · Andreas Pflaumer9,10,11 · Paul James12 · Dion Stub1,2,13 · André La Gerche1,2,3 · Dominica Zentner7,15 · Sarah Parsons4,14 Accepted: 19 October 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020

Abstract This study sought to explore the feasibility and utility of post-mortem coronary artery calcium (CAC) scoring in identifying patients with ischemic heart disease as cause of sudden death. 100 deceased patients aged 18–50 years underwent postmortem examination in the setting of sudden death. At post-mortem, fifty cases were determined to have ischemic heart disease, and fifty had death attributed to trauma or unascertained causes. The CAC score was calculated in a blinded manner from post-mortem CTs performed on all cases. CAC scores were assessable in 97 non-decomposed cases (feasibility 97%). The median CAC score was 88 Agatston units [IQR 0–286] in patients deceased from ischemic heart disease vs 0 [IQR 0–0] in patients deceased from other causes (p  100 (n = 22) had ischemic heart disease as the cause of death. Fifteen cases had a CAC score of zero but severe coronary disease at post-mortem examination. Post-mortem CAC scoring is highly feasible. An elevated CAC score in cases 18–50 years old with sudden death predicts ischemic heart disease at post-mortem examination. However, a CAC score of zero does not exclude significant coronary artery disease. Post-mortem CAC score may be considered as a further assessment tool to help predict likely cause of death when there is an objection to or unavailability of post-mortem examination. Keywords  Post-mortem · Ischemic heart disease · Coronary artery calcium score · Autopsy Dominica Zentner and Sarah Parsons shared senior authorship. * Elizabeth D. Paratz [email protected]

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Royal Children’s Hospital, 50 Flemington Rd, Parkville Melbourne, VIC 3052, Australia

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Department of Paediatrics, Melbourne University, Parkville, VIC 3010, Australia

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Murdoch Children’s Research Institute, Royal Children’s Hospital, Flemington Rd, Parkville, VIC 3052, Australia

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Peter MacCallum Cancer Centre, 305 Grattan St, Parkville, VIC 3050, Australia

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Ambulance Victoria, 375 Manningham Rd, Doncaster, VIC 3108, Australia

Department of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne 3004, Australia

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Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne, VIC, Australia

Department of Forensic Medicine, Monash University, 65 Kavanagh St, Southbank, VIC 3006, Australia

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Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC 3050, Australia

Royal Melbourne Hospital Clinical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC 3000, Australia

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Centenary Institu