背景:在美国消防员中,心源性猝死占与职责相关的死亡比例最大。需要更多地了解心源性猝死的病理解剖原因以及与潜在心脏病理相关的风险,以制定基于证据的筛查建议。方法和结果使用1999年至2014年期间与职责相关的消防员死亡的尸检数据,这项回顾性病例对照研究比较了18至65岁因心脏相关原因死亡的男性消防员的心脏检查结果与非心脏创伤相关原因死亡的人。分析了276例心脏病例和351例非心脏创伤对照的数据。在心脏病病例中,最普遍(82%)的潜在病理基础是冠心病和心脏肥大/左心室肥厚的合并症.心脏病例的心脏肿大患病率较高(心脏重量>450g),左心室肥厚(左心室壁厚度≥1.2cm),和严重的冠状动脉狭窄(≥75%)比创伤对照组(所有P<0.001)。在多变量分析中,心脏重量>450克,冠状动脉狭窄≥75%,先前心肌梗死的证据是心脏死亡的强独立预测因子,赔率比为6.1(95%置信区间,3.6-10.4),9.3(95%置信区间,5.3-16.1),和6.2(95%置信区间,3.4-11.3),分别。结论大多数心源性死亡有冠心病和心脏质量增加的证据,每种情况都与心脏死亡风险显著升高独立相关。冠心病的针对性筛查,心脏质量增加,和先前心肌梗死的证据应被考虑以减少消防员与职责相关的心脏死亡。
Background Sudden cardiac death accounts for the greatest proportion of duty-related deaths among US firefighters. Increased understanding of the pathoanatomic causes of sudden cardiac death and the risk associated with underlying cardiac pathologies is needed to develop evidence-based screening recommendations. Methods and Results Using autopsy data for duty-related firefighter fatalities occurring between 1999 and 2014, this retrospective
case-control study compared cardiac findings of male firefighters aged 18 to 65 years who died on duty of cardiac-related causes with those who died of noncardiac trauma-related causes. Data from 276 cardiac cases and 351 noncardiac trauma controls were analyzed. Among cardiac cases, the most prevalent (82%) underlying pathoanatomic substrate was comorbid coronary heart disease and cardiomegaly/left ventricular hypertrophy. Cardiac cases had a higher prevalence of cardiomegaly (heart weight >450 g), left ventricular hypertrophy (left ventricular wall thickness ≥1.2 cm), and severe coronary artery stenosis (≥75%) than trauma controls (all P<0.001). In multivariate analyses, heart weight >450 g, coronary artery stenosis ≥75%, and evidence of a prior myocardial infarction were strong independent predictors of cardiac death, with odds ratios of 6.1 (95% confidence interval, 3.6-10.4), 9.3 (95% confidence interval, 5.3-16.1), and 6.2 (95% confidence interval, 3.4-11.3), respectively. Conclusions The majority of cardiac fatalities had evidence of both coronary heart disease and increased heart mass, and each condition was independently associated with a markedly elevated risk of cardiac death. Targeted screening for coronary heart disease, increased heart mass, and evidence of prior myocardial infarction should be considered to reduce duty-related cardiac deaths among firefighters.