Clinical characteristics of aortic aneurysm and dissection as a cause of sudden death in outpatients.

Objective: To describe characteristics of nonhospitalized patients experiencing sudden death from aortic causes and compare with characteristics of patients experiencing nontraumatic, unexpected, outpatient death from other causes.

Methods: Retrospective case-control analysis of patients aged 18 to 65 years with nontraumatic, unexpected, outpatient cardiac arrest, emergency department (ED) resuscitation attempts, and autopsy-determined cause of death. Demographics, prodromal symptoms, and arrest characteristics were examined, and univariate comparisons between patients with aortic and those with nonaortic causes of death were performed.

Results: A total of 384 patients met inclusion criteria. Aortic pathology represented 4.4% of patients (12 dissections, 5 aneurysms). Preexisting aortic disease (n = 2) and antemortem suspicion of an aortic cause (n = 3) were uncommon. Patients with an aortic cause of death often had prodromal symptoms (53% 95% CI; 28%-77%) and hemopericardium (47% 95% CI; 23%-72%), were older, and were more likely to have a pulse in the ED, an arrest rhythm of pulseless electrical activity, and an arrest witnessed arrest by a medical provider.

Conclusion: In this sample of outpatients with cardiac arrest from aortic disease, death was not instantaneous, and hemopericardium was common in many patients with dissection.