A Retrospective Study On Forensic Medicine Of 369 Cases Of Sudden Death Of Coronary Heart Disease

Background and purpose: Coronary heart disease(coronary atherosclerotic heart diseases,CHD)is a kind of common disease,frequently-occurring disease of human beings.The sudden death of coronary heart disease(sudden coronary death,SCD)is the most common type of sudden death.SCD is a kind of natural death.It can happen in a variety of incentives,such as,in the process of dispute and tussle,of working,of sports,of drinking,even during sleep,and so on.Because of its death quickly(often less than 1 hour from onset to death,sometimes in a few seconds to death,which is called the instant death),and the former half of patients without aura symptoms or mild easily overlooked,death appear unexpectedly,SCD is often suspected to be an abnormal death caused by trauma,fatigue,medical accident or poisoning,etc.And the cause of death is disputed.Resolving the cause of death dispute is an important task of forensic pathology examination.In the practice of judicial authentication,SCD caused disputes has a quite proportion of cases.For further ascertain the pathological changes and pathogenesis regularity,we selected 369 SCD cases from all kinds of forensic pathology cases in Judicial Authentication Center of the University in 2007-2017 for analysis.And we compared the total of 192 cases of SCD induced by dispute and tussleb with the total of 123 cases of SCD in quiet condition,in order to provide the beneficial reference for the prevention of SCD and forensic medical identification.Material: We selected 369 SCD cases from more than 2000 of forensic pathology cases in Judicial Authentication Center of the University in 2007-2017 for analysis,including 326 males and 43 females.Inclusion criteria: SCD with complete autopsy data and autopsy photos;the diagnosis of CHD was determined by forensic pathology;Original records and medical records excluded other death causes of violence,poison,suicide,etc.;Having a general specimen of the heart;There were pathological wax blocks and H.E.slices could be check.Exclusion criteria: All cases that do not meet the sudden coronary death or the causes of death are in competition.Method: Statistics of 369 cases of SCD from gender,age,occupation,the time of death,inducement,preserving heart,brain,spleen,kidney and so on various organs in general situation and characteristics of the lesions,the distribution of major coronary atherosclerosis plaque,the degree of stenoses and complications.SPSS 24.0 was used to analyze and verify the differences among the groups.Results: 1.Relationship between age and gender: 369 cases of SCD were distributed in all ages of 20 years old and above,with a ratio of 7.6 to 1.The incidence of cases of men was mainly between 40 ~ 69 years,the average age is 53.1 years old.The incidence of cases of women was mainly between predilection age is 50 ~59 years,the average age of women is 59.3 years old.The incidence rate of males was greater than that of women at all ages.There is a significant relationship between age and sex(P< 0.05).2.Occupational and gender distribution: The proportion of farmers in all occupation is the largest;there was no significant difference in male and female morbidity among different occupations(P< 0.05).3.Time distribution: SCD mostly occurs in the first quarter of each year,especially in January and February(P< 0.05).4.Inducement characteristics: Dispute and tussle is the main cause of SCD in forensic pathology practice,and its significance is statistically significant(P< 0.05).5.The pathological changes of the organs indicated that the majority of cases of SCD are characterized by hypertension.In the case of SCD induced by dispute and tussle,the ratio of patients with hypertension to sudden death of CHD is higher than that in the quiet state,and the disease is more serious.There is a significant correlation between hypertension and SCD(P< 0.05).6.Cardiac pathological changes suggested that the myocardial infarction of sudden death from CHD induced by dispute and tussle was more serious and significant difference than in the quiet state(P< 0.05).7.Predilection part of coronary atherosclerotic plaque: most commonly occurs in the left anterior descending artery(LAD),often involving the right coronary artery(RCA)at the same time,both the affected and narrow Ⅲ level and above accounted for 95.9%,and both in the SCD has significantly close correlation(P< 0.05).The severity of LAD and RCA stenoses between induced by dispute and tussle and in quiet state is different,the significant difference is statistically significant(P< 0.001).8.Plaque complications: the proportion of sudden thrombosis of CHD induced by dispute and tussle is significantly lower than that in the quiet state,and the significant difference was statistically significant(P< 0.01).Conclusion: This topic is a retrospective study of 369 SCD cases from forensic pathology cases in Judicial Authentication Center of the University in 2007-2017.And we compared the total of 192 SCD cases induced by dispute and tussle with the total of 123 SCD cases in quiet state,and we came to the following conclusions: 1.The characteristics of hypertensive disease and myocardial infarction in the SCD cases induced by dispute and tussle were more and worse than those in the SCD cases in the quiet state.2.The proportion of coronary artery thrombosis in the SCD cases induced by dispute and tussle was significantly lower than that in the quiet state.