Can post-mortem coronary artery calcium scores aid diagnosis in young sudden death?

Elizabeth D. Paratz, Ben Costello, Luke Rowsell, Natalie Morgan, Karen Smith, Tina Thompson, Chris Semsarian, Andreas Pflaumer, Paul James, Dion Stub, André La Gerche, Dominica Zentner, Sarah Parsons

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This study sought to explore the feasibility and utility of post-mortem coronary artery calcium (CAC) scoring in identifying patients with ischemic heart disease as cause of sudden death. 100 deceased patients aged 18–50 years underwent post-mortem examination in the setting of sudden death. At post-mortem, fifty cases were determined to have ischemic heart disease, and fifty had death attributed to trauma or unascertained causes. The CAC score was calculated in a blinded manner from post-mortem CTs performed on all cases. CAC scores were assessable in 97 non-decomposed cases (feasibility 97%). The median CAC score was 88 Agatston units [IQR 0–286] in patients deceased from ischemic heart disease vs 0 [IQR 0–0] in patients deceased from other causes (p < 0.0001). Presence of any coronary calcification differed significantly between ischemic heart disease and non-ischemic groups (adjusted odds ratio 10.7, 95% CI 3.2—35.5). All cases with a CAC score > 100 (n = 22) had ischemic heart disease as the cause of death. Fifteen cases had a CAC score of zero but severe coronary disease at post-mortem examination. Post-mortem CAC scoring is highly feasible. An elevated CAC score in cases 18–50 years old with sudden death predicts ischemic heart disease at post-mortem examination. However, a CAC score of zero does not exclude significant coronary artery disease. Post-mortem CAC score may be considered as a further assessment tool to help predict likely cause of death when there is an objection to or unavailability of post-mortem examination.

Original languageEnglish
Pages (from-to)27-35
Number of pages9
JournalForensic Science, Medicine and Pathology
Issue number1
Publication statusPublished - Mar 2021


  • Autopsy
  • Coronary artery calcium score
  • Ischemic heart disease
  • Post-mortem

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