Forensic pathological and histopathological analysis of ischemic sudden cardiac deaths in Egypt

Abstract Background Ischemic heart disease (IHD) is the leading contributor to sudden cardiac death (SCD), which continues to pose an increasing global health challenge. In Egypt, existing research has primarily focused on clinical or general postmortem studies. This study presents the first comprehensive autopsy-based analysis of ischemic SCD in Egypt, offering detailed forensic and histopathological insights across age groups, with particular focus on cases under 40 and those involving acute myocardial infarction (MI). Subjects and methods Five hundred twenty-two cases of ischemic SCDs were analyzed. We documented demographic data, history, and autopsy findings for each case. The hearts were subjected to detailed gross and histopathological examination. We reported the type of atherosclerosis (types I–VI), the degree of vascular stenosis and acute events. The myocardium was examined to determine the extent and timing of MI. Results About 60% of the cases were > 50 years old, 26.2% were between 40 and 50, and the least frequent occurrences were in individuals < 40. Males constituted 90.4%, with a significant association between age and sex ( p = 0.003). Coronary atherosclerosis and MI-related parameters significantly worsened with age ( p < 0.05). Individuals under 40 years old had significantly higher prevalence of anemia and family history of dyslipidemia. Intramural coronary arteries were only observed in individuals < 40. We observed that 86.1% of those < 40 exhibited focal MI compared to those above 50, who showed significantly more diffuse or laminar MI (36.4%) ( p = 0.000). Concerning the aging of MI, healed lesions were significantly less frequently observed in cases < 40 than in older cases ( p = 0.000). By comparing the features of acute versus recurrent MI, acute MI was significantly more prevalent among those < 40 ( p = 0.010). All deceased cases with intramural coronaries developed acute MI ( p = 0.004). Hypertensive cardiomyopathy was significantly associated with recurrent MI ( p = 0.000). Mural thrombi and ruptured hearts were exclusively reported in acute MI. Conclusions The risk of ischemic SCD increases with age. The current study pointed to anemia, dyslipidemia, and hypertension as potential risk factors. However, future autopsy-based prospective studies are needed to strengthen the evidence and guide effective prevention strategies. Additionally, comprehensive autopsies are recommended for all cases of sudden death (SD).