A Regional Centre Experience on Cardiac Resynchronisation Therapy—A Five-year Audit at The Gold Coast Hospital (GCH)

Abstract

Background: Coronary artery disease (CAD) is the most common cause of sudden cardiac death (SCD) in Australians aged <40 years. The relevance of post-mortem lipid levels in this setting is currently unknown. Aim: We investigated post-mortem lipid levels in consecutive decedents with a spectrum of CAD in whom a coronial inquest was performed to elucidate a cause of death between 2006 and 2009. Methods: Seventy-two decedents aged 39 ± 7 years (range 18-49 years) and 92% males were investigated. Decedents either had obstructive CAD (>70% stenosis, n = 51), non-obstructive CAD (<70% stenosis, n = 15) or normal coronary arteries (n = 6). The post-mortem concluded that CAD was the cause of death in all cases of obstructive CAD, where as CAD was unrelated to the cause of death in non-obstructive cases or where there were normal coronary arteries. Post-mortem blood samples were analysed for total cholesterol, apolipoprotein B (ApoB), high-density lipoprotein (HDL), apolipoprotein AI (ApoAI), lipoprotein(a), cotinine, HbA1c and C-Reactive Protein (CRP). Results: Post-mortem ApoB (1.33 ± 0.5 vs 1.04 ± 0.39 g/L, p = 0.04) and total cholesterol levels (7.98 ± 2.7 vs 5.67 ± 2.39 mmol/L, p = 0.002) were significantly higher in decedents with obstructive CAD compared with non-obstructive CAD. ApoB levels were also significantly elevated when decedents with obstructive CAD were compared to decedents with normal coronary arteries (1.32 ± 0.5 vs 0.87 ± 0.39 g/L, p = 0.04). There were no significant differences in HDL, ApoAI, lipoprotein(a), cotinine, HbA1c and CRP between groups. Conclusions: Post-mortem ApoB and total cholesterol levels may provide insights into mechanisms associated with fatal premature CAD and have implications for screening of first-degree relatives.