Autopsy investigation and Bayesian approach to coronary artery disease in victims of motor-vehicle accidents

• Published in: Atherosclerosis Vol. 218; no. 1; pp. 28 - 32
• Main Authors: Oliva, Antonio, Flores, Jose, Merigioli, Sara, LeDuc, Louis, Benito, Begoña, Partemi, Sara, Arzamendi, Dabit, Campuzano, Oscar, Leung, Tack Li, Iglesias, Anna, Talajic, Mario, Pascali, Vincenzo L, Brugada, Ramon
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Ireland Ltd 01.09.2011; Elsevier
• Subjects: accidents; Accidents, Traffic - mortality; Adult; Aged; Aged, 80 and over; Algorithms; Atherosclerosis; Atherosclerosis (general aspects, experimental research); Atherosclerosis - pathology; Autopsy; Bayes Theorem; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Cardiovascular; coronary artery disease; Coronary Artery Disease - diagnosis; Coronary Artery Disease - epidemiology; Coronary disease; Coronary heart disease; coronary vessels; death; Death, Sudden; Female; health services; Heart; Humans; Male; Medical sciences; men; Middle Aged; Myocardial infarction; Myocardial Ischemia - pathology; necropsy; Pathology; patients; Plaque; Plaque, Atherosclerotic - pathology; Prevalence; Probability; Quebec; Risk; risk assessment; statistical analysis; women; Quebec; Myocardial infarction; Pathology; Coronary disease; Atherosclerosis; Plaque; Vascular disease; Anatomic pathology; Autopsy; Cardiovascular disease; Myocardial disease; Coronary heart disease
• ISSN: 0021-9150; 1879-1484
• DOI: 10.1016/j.atherosclerosis.2011.05.012

Abstract Background Each year, 1.2 million people die worldwide as a result of motor-vehicle accidents (MVA), representing a tremendous burden to healthcare. The aim of this study was to define the prevalence of coronary disease and its possible role in motor-vehicle accidents. Methods and results We examined consecutive cases of non-hospital sudden death autopsies in the area of West Quebec during the period of 2002–2006, and we focused on those victims of MVA. Severe coronary artery disease (CAD) was defined as a narrowing of ≥75% of a cross-sectional area or the presence of acute plaque events in major epicardial coronary arteries. From a total cohort of 1260 autopsies, MVA were responsible for 123 deaths, 100 of whom were men and 23 were women. Significant CAD was documented in approximately 37% of these cases. In individuals older than 60 years, the prevalence of significant CAD and ischemia were 86.2% and 19.8%, respectively. A percentage of 40% of the coronary patients showed erratic driving before the accident, as observed by witnesses. Statistical analysis showed that an individual affected by CAD has 9% probability of suffering a motor-vehicle accident. Conclusions The prevalence of severe CAD and acute myocardial ischemia is very high among individuals who have suffered a MVA. Our data suggest the hypothesis that acute CAD could be the cause of accidents in a large group of the drivers affected by coronary disease. For these reasons CAD could be investigated in drivers above 50 years old, as a possible preventive measure and determinant of individual risk stratification.