Insights into Pre-COVID sudden cardiac deaths-: An autopsy study in South India.

Background: Sudden cardiac death poses the major healthcare crisis globally and is becoming a significant concern in India. There is a scarcity of comprehensive data on the prevalence, contributing factors, and underlying causes in the Indian context. This study aims to identify demographic patterns, key cardiac pathologies, and associated lifestyle factors, in cases of sudden cardiac death in the South Indian population and to provide insights for public health interventions. Materials and Methods: This single-center cross-sectional study was conducted in a government tertiary care center in South India, involving autopsies registered from 2017-2019 for identification of the cause of death. Demographic data, relevant medical history, and events preceding death were collected from the relatives of the victims and medical records. Patients with a history of trauma, positive toxicological findings, and pathological findings in other organs were excluded from the study. Detailed gross and microscopic examinations of heart samples were performed to assess coronary and myocardial pathologies. Results: The mean age was 48 years, with a male preponderance. Lifestyle factors, including a lack of physical activity, smoking, and alcohol consumption, were the critical factors contributing to sudden death in the younger age group. coronary artery disease (CAD), predominantly acute Myocardial Infarction (MI), was identified as the leading cause of death. Surprisingly, 41% of the patients with histopathological changes of MI in myocardium showed less than severe stenosis in the coronaries. Conclusion: Coronary artery disease, particularly acute MI, is the primary cause of sudden cardiac death in South India, with lifestyle factors such as smoking, physical inactivity, and alcohol abuse as significant contributors. Higher coronary atherosclerotic plaque burden is associated with major adverse cardiac events. This study underscores the need for molecular autopsies, lifestyle-focused interventions, early CAD detection, and Cardio-pulmonary resuscitation (CPR) training. Establishing a sudden cardiac death (SCD) registry and enhancing resuscitation measures are crucial for reducing its impact.