Sudden death in young adults: a 25-year review of autopsies in military recruits.
Level 3 - non-randomized controlled study
Retrospective cohort study of mortality registry data from a monitored population.
PubMed 15583223 · doi:10.7326/0003-4819-141-11-200412070-00005
What was done
A retrospective cohort study analyzed demographic and autopsy data from the Department of Defense Recruit Mortality Registry over a 25-year period. The monitored population consisted of 6.3 million men and women aged 18 to 35 years undergoing basic military training, all of whom underwent preenlistment screening with a medical history and physical examination. Investigators assessed the incidence, circumstances, and specific anatomical causes of all nontraumatic sudden deaths.
What was found
There were 126 nontraumatic sudden deaths, yielding a mortality rate of 13.0 per 100,000 recruit-years. Most deaths (108 of 126, 86%) were exercise-related. An identifiable cardiac abnormality was the primary cause in 64 of 126 deaths (51%), whereas 44 of 126 deaths (35%) remained unexplained after autopsy. Among the 64 cardiac deaths, coronary artery abnormalities were the most common finding (39 recruits, 61%), followed by myocarditis (13 recruits, 20%) and hypertrophic cardiomyopathy (8 recruits, 13%). In 21 recruits (33% of cardiac cases), an anomalous left coronary artery originated from the right anterior sinus of Valsalva and coursed between the pulmonary artery and aorta.
Why it matters
This study provides large-scale epidemiological data on nontraumatic sudden death in young, active adults, identifying anomalous coronary arteries as the leading structural cardiovascular cause in screened individuals while showing that more than one third of sudden deaths lack an identifiable postmortem cause.
Limits
The population was limited to young military recruits who passed baseline physical screening, which excludes individuals with previously recognized conditions and limits generalizability to the general public. As an autopsy registry review, it only captures fatal events and cannot determine molecular or electrophysiological causes in the 35% of cases that were structurally normal.
Cited by
- contradicts The most common cause of sudden cardiac death in military recruits during basic training is viral myocarditis.