Abstract
To define the association between severe coronary artery disease and widespread atherosclerosis in younger individuals. Individuals aged 1-50 years with sudden cardiac death (SCD) from 2019-23, autopsy-proven to be due to coronary artery disease, were identified using the state-wide EndUCD registry. Presence of extra-coronary atherosclerosis greater than modified American Heart Association class III was assessed in 5 arterial beds (intra-cerebral vessels, aorta, carotid, renal and femoral arteries). 3,044 individuals experienced SCD; 356 were due to coronary artery disease and 64 (18.0%) had extra-coronary plaque. Plaque was identified in aorta (61/356 patients, 17.1%), carotid arteries (9/356, 2.5%), iliofemoral arteries (11/356, 3.1%), intracerebral arteries (4/153, 2.6%) and renal arteries (6/356 patients, 1.7%). The only feature associated with extra-coronary plaque was older age (median 47.8 vs 44.4 years, p=0.0002). Patients with extra-coronary plaque had higher rates of cardiomegaly (67.2% vs 50.7%, p=0.022), cardiac fibrosis indicative of previous myocardial infarction (45.3% vs 31.2%, p=0.030) and multi-vessel coronary disease (72.6% vs 55.6%, p=0.014). Fewer than 1 in 5 people aged 1-50 years experiencing SCD from a coronary cause exhibit extra-coronary plaque, suggesting that in young people severe atherosclerosis is not necessarily a systemic disease. This limits the utility of screening for carotid or aortic plaque to predict coronary atherosclerosis on an individual level. Individuals with extra-coronary plaque were older with more established coronary disease.
Published Version
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