Sudden Death in the Young: A Nationwide Prospective Epidemiological Study of Sudden Death in Young People Aged 1-35 Years in the Mediterranean Island of Cyprus.

Abstract

Background and aims: This study aimed to explore the etiology, incidence, and epidemiological characteristics of sudden death (SD) cases among individuals aged 1-35 years, through a systemic evaluation of all SDs in Cyprus over a 11-year period.

Methods and results: From 2005 to 2015, all cases of SDs involving individuals aged 1-35 years, who were citizens or permanent residents of the Republic of Cyprus, were recorded and studied. The incidence of SD in young individuals in Cyprus was 2.16 cases per 100 000 people annually. Out of the 74 recorded cases, cardiac causes were identified in 43.24% (n = 32) of SD cases, with 28.38% (n = 21) attributed to noncardiac factors. Cardiac causes predominated in males (n = 25/50, 50.00%), while noncardiac causes were more prevalent in females (n = 12/24, 50.00%). Among all SD cases, cardiomyopathies, particularly hypertrophic cardiomyopathy, accounted for 24.32% (n = 18) cases, followed by pulmonary embolism (n = 8, 10.81%) and viral myocarditis (n = 7, 9.46%) as the second and third leading causes, respectively. Other causes of SDs were myocardial infarction (n = 5, 6.76%), and hemorrhagic stroke (n = 4, 5.41%). Aortic aneurysm rupture, adrenal hemorrhage, and pulmonary aspiration each constituted 4.05% (n = 3) of SD cases. The cause of death remained indeterminate in 28.38% (n = 21) of SD cases.

Conclusions: SD in the young is predominantly of cardiac origin, although a significant proportion of cases is also attributed to noncardiac causes. Despite thorough post-mortem examinations, including microscopic pathology, histological, and immune-histological analyses, a considerable number of SD cases remain unclear.