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Jack L Cronenwett - One of the best experts on this subject based on the ideXlab platform.
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restenosis after carotid endarterectomy in a multicenter Regional Registry
Journal of Vascular Surgery, 2010Co-Authors: Philip P Goodney, Brian W Nolan, Jens Eldrupjorgensen, Donald S Likosky, Jack L CronenwettAbstract:Background Level I evidence shows conventional carotid endarterectomy (CEA) with patch angioplasty results in lower rates of restenosis. However, whether this information has affected practice patterns and outcomes in real-world vascular surgery settings is unclear. Methods Within the Vascular Study Group of New England (VSGNE), we studied 2981 patients undergoing 2981 first-time CEAs between January 1, 2003, and June 31, 2008. Rates of restenosis (defined by duplex ultrasound imaging at the 1-year follow-up) were estimated using life-table analysis. Cox proportional hazards models were used to identify multivariable predictors of postoperative restenosis ≤1 year. Results Across 58 surgeons and 11 hospitals, we studied 2611 conventional CEAs (88% of all CEAs) and 370 eversion CEAs (12% of all CEAs). Median follow-up was 12.8 months (range, 1-35 months). The proportion of conventional CEAs performed with patching increased from 87% to 96% ( P P P P P 80% (HR, 4.1; 95% CI, 1.4-11.5), and dialysis dependence (HR, 3.5; 95% CI, 1.2-9.8) were independently associated with a higher risk of an 80% to 100% restenosis. Of the 51 patients with 80% to 99% restenosis, 14 underwent reintervention ≤1 year, comprising 4 reoperations and 10 carotid artery stent procedures. Of the 15 patients with a carotid occlusion ≤1 year, transient ischemic attacks occurred in 2 and a disabling stroke in 1. Conclusions In our region, restenosis after CEA, especially clinically significant restenosis ≤1 year after surgery, decreased slightly over time. This improvement in outcome was associated with several factors, including an increase in patching after conventional CEA, a process of care that was studied and encouraged within our vascular study group. These results highlight the utility of Regional quality-improvement efforts in improving outcomes in vascular surgery.
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protamine reduces bleeding complications associated with carotid endarterectomy without increasing the risk of stroke
Journal of Vascular Surgery, 2009Co-Authors: David H Stone, Philip P Goodney, Brian W Nolan, Donald S Likosky, Andres Schanzer, Robert A Cambria, Daniel B Walsh, Jack L CronenwettAbstract:Objectives Controversy persists regarding the use of protamine during carotid endarterectomy (CEA) based on prior conflicting reports documenting both reduced bleeding as well as increased stroke risk. The purpose of this study was to determine the effect of protamine reversal of heparin anticoagulation on the outcome of CEA in a contemporary multistate Registry. Methods We reviewed a prospective Regional Registry of 4587 CEAs in 4311 patients performed by 66 surgeons from 11 centers in Northern New England from 2003-2008. Protamine use varied by surgeon (38% routine use, 44% rare use, 18% selective use). Endpoints were postoperative bleeding requiring reoperation as well as potential thrombotic complications, including stroke, death, and myocardial infarction (MI). Predictors of endpoints were determined by multivariate logistic regression after associated variables were identified by univariate analysis. Results Of the 4587 CEAs performed, 46% utilized protamine, while 54% did not. Fourteen patients (0.64%) in the protamine-treated group required reoperation for bleeding compared with 42 patients (1.66%) in the untreated cohort (P = .001). Protamine use did not affect the rate of MI (1.1% vs 0.91%, P = .51), stroke (0.78% vs 1.15%, P = .2), or death (0.23% vs 0.32%, P = .57) between treated and untreated patients, respectively. By multivariate analysis, protamine (odds ratio [OR] 0.32, 95% confidence interval [CI], 0.17-0.63; P = .001) and patch angioplasty (OR 0.46, 95% CI, 0.26-0.81; P = .007) were independently associated with diminished reoperation for bleeding. A single center was associated with a significantly higher rate of reoperation for bleeding (OR 6.47, 95% CI, 3.02-13.9; P Conclusion Protamine reduced serious bleeding requiring reoperation during CEA without increasing the risk of MI, stroke, or death, in this large, contemporary Registry. In light of significant complications referable to bleeding, liberal use of protamine during CEA appears warranted.
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a Regional Registry for quality assurance and improvement the vascular study group of northern new england vsgnne
Journal of Vascular Surgery, 2007Co-Authors: Jack L Cronenwett, Jens Eldrupjorgensen, Donald S Likosky, Margaret T Russell, Andrew C Stanley, Brian W NolanAbstract:Objective A Regional cooperative data Registry was organized for carotid endarterectomy (CEA), lower extremity bypass (LEB), and infrarenal abdominal aortic aneurysm (AAA) repair (open and endovascular) procedures in Northern New England to allow benchmarking among centers for quality assurance and improvement activities. Methods Since January 2003, 48 vascular surgeons from nine hospitals in Maine, New Hampshire, and Vermont (25 to 615 beds) have prospectively recorded patient, procedure, and in-hospital patient outcome data. Results plus 1-year follow-up data analyzed at a central site are reported anonymously to each center at semiannual meetings where care processes and Regional benchmarks are discussed. Mortality and compliance with procedure entry were validated by independent comparison with hospital administrative data. Initial improvement efforts focused on optimizing preoperative medication usage. Results A total of 6143 operations were entered into the Registry through December 2006. In-hospital stroke or death after CEA was 1.0%, major amputation or death after LEB was 3.8%, and mortality was 2.9% after elective open and 0.4% after endovascular repair. Variation in results between centers and surgeons provides opportunity for further quality improvement. Any postoperative complication increased median length of stay by ≥3 days. Process improvement efforts initiated in 2004 increased preoperative β-blocker administration from 72% to 91%, antiplatelet agents from 73% to 83%, and statins from 54% to 72% (all P Conclusion This validated Regional data Registry within a quality improvement initiative has been associated with improved preoperative medication usage. It provides a potential vehicle for future public and pay-for-performance reporting and has the potential to improve patient outcomes. It has been sustained for >4 years and is a model that could be adopted by other regions.
Donald S Likosky - One of the best experts on this subject based on the ideXlab platform.
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restenosis after carotid endarterectomy in a multicenter Regional Registry
Journal of Vascular Surgery, 2010Co-Authors: Philip P Goodney, Brian W Nolan, Jens Eldrupjorgensen, Donald S Likosky, Jack L CronenwettAbstract:Background Level I evidence shows conventional carotid endarterectomy (CEA) with patch angioplasty results in lower rates of restenosis. However, whether this information has affected practice patterns and outcomes in real-world vascular surgery settings is unclear. Methods Within the Vascular Study Group of New England (VSGNE), we studied 2981 patients undergoing 2981 first-time CEAs between January 1, 2003, and June 31, 2008. Rates of restenosis (defined by duplex ultrasound imaging at the 1-year follow-up) were estimated using life-table analysis. Cox proportional hazards models were used to identify multivariable predictors of postoperative restenosis ≤1 year. Results Across 58 surgeons and 11 hospitals, we studied 2611 conventional CEAs (88% of all CEAs) and 370 eversion CEAs (12% of all CEAs). Median follow-up was 12.8 months (range, 1-35 months). The proportion of conventional CEAs performed with patching increased from 87% to 96% ( P P P P P 80% (HR, 4.1; 95% CI, 1.4-11.5), and dialysis dependence (HR, 3.5; 95% CI, 1.2-9.8) were independently associated with a higher risk of an 80% to 100% restenosis. Of the 51 patients with 80% to 99% restenosis, 14 underwent reintervention ≤1 year, comprising 4 reoperations and 10 carotid artery stent procedures. Of the 15 patients with a carotid occlusion ≤1 year, transient ischemic attacks occurred in 2 and a disabling stroke in 1. Conclusions In our region, restenosis after CEA, especially clinically significant restenosis ≤1 year after surgery, decreased slightly over time. This improvement in outcome was associated with several factors, including an increase in patching after conventional CEA, a process of care that was studied and encouraged within our vascular study group. These results highlight the utility of Regional quality-improvement efforts in improving outcomes in vascular surgery.
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the association of perioperative red blood cell transfusions and decreased long term survival after cardiac surgery
Anesthesia & Analgesia, 2009Co-Authors: Stephen D Surgenor, Donald S Likosky, Robert S Kramer, Elaine M Olmstead, Cathy S Ross, Frank W Sellke, Charles A S Marrin, Robert E Helm, Bruce J Leavitt, Jeremy R MortonAbstract:BACKGROUND: Exposure to red blood cell (RBC) transfusions has been associated with increased mortality after cardiac surgery. We examined long-term survival for cardiac surgical patients who received one or two RBC units during index hospitalization. METHODS: Nine thousand seventy-nine consecutive patients undergoing coronary artery bypass graft, valve, or coronary artery bypass graft/valve surgery at eight centers in northern New England during 2001-2004 were examined after exclusions. A probabilistic match between the Regional Registry and the Social Security Administration's Death Master File determined mortality through June 30, 2006. Cox Proportional Hazard and propensity methods were used to calculate adjusted hazard ratios. RESULTS: Thirty-six percent of patients (n = 3254) were exposed to one or two RBC units. Forty-three percent of RBCs were given intraoperatively, 56% in the postoperative period and 1% were preoperative. Patients transfused were more likely to be anemic, older, smaller, female and with more comorbid illness. Survival was significantly decreased for all patients exposed to 1 or 2 U of RBCs during hospitalization for cardiac surgery compared with those who received none (P < 0.001). After adjustment for patient and disease characteristics, patients exposed to 1 or 2 U of RBCs had a 16% higher long-term mortality risk (adjusted hazard ratios = 1.16, 95% CI: 1.01-1.34, P = 0.035). CONCLUSIONS: Exposure to 1 or 2 U of RBCs was associated with a 16% increased hazard of decreased survival after cardiac surgery.
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protamine reduces bleeding complications associated with carotid endarterectomy without increasing the risk of stroke
Journal of Vascular Surgery, 2009Co-Authors: David H Stone, Philip P Goodney, Brian W Nolan, Donald S Likosky, Andres Schanzer, Robert A Cambria, Daniel B Walsh, Jack L CronenwettAbstract:Objectives Controversy persists regarding the use of protamine during carotid endarterectomy (CEA) based on prior conflicting reports documenting both reduced bleeding as well as increased stroke risk. The purpose of this study was to determine the effect of protamine reversal of heparin anticoagulation on the outcome of CEA in a contemporary multistate Registry. Methods We reviewed a prospective Regional Registry of 4587 CEAs in 4311 patients performed by 66 surgeons from 11 centers in Northern New England from 2003-2008. Protamine use varied by surgeon (38% routine use, 44% rare use, 18% selective use). Endpoints were postoperative bleeding requiring reoperation as well as potential thrombotic complications, including stroke, death, and myocardial infarction (MI). Predictors of endpoints were determined by multivariate logistic regression after associated variables were identified by univariate analysis. Results Of the 4587 CEAs performed, 46% utilized protamine, while 54% did not. Fourteen patients (0.64%) in the protamine-treated group required reoperation for bleeding compared with 42 patients (1.66%) in the untreated cohort (P = .001). Protamine use did not affect the rate of MI (1.1% vs 0.91%, P = .51), stroke (0.78% vs 1.15%, P = .2), or death (0.23% vs 0.32%, P = .57) between treated and untreated patients, respectively. By multivariate analysis, protamine (odds ratio [OR] 0.32, 95% confidence interval [CI], 0.17-0.63; P = .001) and patch angioplasty (OR 0.46, 95% CI, 0.26-0.81; P = .007) were independently associated with diminished reoperation for bleeding. A single center was associated with a significantly higher rate of reoperation for bleeding (OR 6.47, 95% CI, 3.02-13.9; P Conclusion Protamine reduced serious bleeding requiring reoperation during CEA without increasing the risk of MI, stroke, or death, in this large, contemporary Registry. In light of significant complications referable to bleeding, liberal use of protamine during CEA appears warranted.
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a Regional Registry for quality assurance and improvement the vascular study group of northern new england vsgnne
Journal of Vascular Surgery, 2007Co-Authors: Jack L Cronenwett, Jens Eldrupjorgensen, Donald S Likosky, Margaret T Russell, Andrew C Stanley, Brian W NolanAbstract:Objective A Regional cooperative data Registry was organized for carotid endarterectomy (CEA), lower extremity bypass (LEB), and infrarenal abdominal aortic aneurysm (AAA) repair (open and endovascular) procedures in Northern New England to allow benchmarking among centers for quality assurance and improvement activities. Methods Since January 2003, 48 vascular surgeons from nine hospitals in Maine, New Hampshire, and Vermont (25 to 615 beds) have prospectively recorded patient, procedure, and in-hospital patient outcome data. Results plus 1-year follow-up data analyzed at a central site are reported anonymously to each center at semiannual meetings where care processes and Regional benchmarks are discussed. Mortality and compliance with procedure entry were validated by independent comparison with hospital administrative data. Initial improvement efforts focused on optimizing preoperative medication usage. Results A total of 6143 operations were entered into the Registry through December 2006. In-hospital stroke or death after CEA was 1.0%, major amputation or death after LEB was 3.8%, and mortality was 2.9% after elective open and 0.4% after endovascular repair. Variation in results between centers and surgeons provides opportunity for further quality improvement. Any postoperative complication increased median length of stay by ≥3 days. Process improvement efforts initiated in 2004 increased preoperative β-blocker administration from 72% to 91%, antiplatelet agents from 73% to 83%, and statins from 54% to 72% (all P Conclusion This validated Regional data Registry within a quality improvement initiative has been associated with improved preoperative medication usage. It provides a potential vehicle for future public and pay-for-performance reporting and has the potential to improve patient outcomes. It has been sustained for >4 years and is a model that could be adopted by other regions.
Gherardo Finocchiaro - One of the best experts on this subject based on the ideXlab platform.
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24 anomalous coronary artery origin and sudden cardiac death data from a large Regional Registry
Heart, 2018Co-Authors: Gherardo Finocchiaro, Michael Papadakis, Harshil Dhutia, Maite Tome, Elijah R Behr, Gaia Tanzarella, Igor Diemberger, Sanjay Sharma, Mary N SheppardAbstract:Background and aims Anomalous origin of a coronary artery (AOCA) from the inappropriate sinus of Valsalva or from the pulmonary artery is increasingly diagnosed with current imaging techniques. Although most AOCA subtypes are benign, they can rarely cause sudden cardiac death (SCD). The aim of the study was to describe the clinical and pathological features of AOCA in SCD victims. Methods We reviewed a database of 5100 consecutive cases of SCDs referred to our specialist cardiac pathology centre between 1994 and March 2017 and identified a subgroup of 30 (0.6%) cases with AOCA. All cases underwent detailed post-mortem evaluation including histological analysis by an expert cardiac pathologist. Clinical information was obtained from referring coroners. Results The mean age was 28±16 years and 23 individuals were males (77%). In 8 (27%) cases SCD occurred before 18 years of age. Cardiac symptoms were present in 11 (37%) individuals and syncope was the most common (n=6, 20%). The mean heart weight was 367±115 g. The most common anomalies were anomalous left coronary artery arising from the right sinus of Valsalva (ALCA) with inter-arterial course (n=11) and anomalous right coronary artery arising from the left sinus of Valsalva (ARCA) with inter-arterial course (n=11). Anomalous left coronary artery arising from pulmonary artery (ALCAPA) was present in 7 cases, while in 1 case the LCA arose from the non-coronaric cusp. Death occurred during exercise in 14 (47%) cases. The AOCA variant where death occurred more frequently during physical activity was ALCA (7/11, 64%), followed by ALCAPA (4/7, 57%) and ARCA (2/11, 18%). Conclusions AOCA is a rare cause of SCD. Anomalous left or right coronary artery arising from the wrong sinus of Valsalva with inter-arterial course is the most common anatomical variant recognised at the post-mortem of SCD victims. While in ALCA death is commonly associated with exercise, in ARCA death occurs usually during rest or sleep.
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etiology of sudden death in sports insights from a united kingdom Regional Registry
Journal of the American College of Cardiology, 2016Co-Authors: Gherardo Finocchiaro, Michael Papadakis, Janlukas Robertus, Harshil Dhutia, Alexandros Steriotis, Maite Tome, Greg Mellor, Ahmed Merghani, Aneil Malhotra, Elijah R BehrAbstract:Abstract Background Accurate knowledge of causes of sudden cardiac death (SCD) in athletes and its precipitating factors is necessary to establish preventative strategies. Objectives This study investigated causes of SCD and their association with intensive physical activity in a large cohort of athletes. Methods Between 1994 and 2014, 357 consecutive cases of athletes who died suddenly (mean 29 ± 11 years of age, 92% males, 76% Caucasian, 69% competitive) were referred to our cardiac pathology center. All subjects underwent detailed post-mortem evaluation, including histological analysis by an expert cardiac pathologist. Clinical information was obtained from referring coroners. Results Sudden arrhythmic death syndrome (SADS) was the most prevalent cause of death (n = 149 [42%]). Myocardial disease was detected in 40% of cases, including idiopathic left ventricular hypertrophy (LVH) and/or fibrosis (n = 59, 16%); arrhythmogenic right ventricular cardiomyopathy (ARVC) (13%); and hypertrophic cardiomyopathy (HCM) (6%). Coronary artery anomalies occurred in 5% of cases. SADS and coronary artery anomalies affected predominantly young athletes (≤ 35 years of age), whereas myocardial disease was more common in older individuals. SCD during intense exertion occurred in 61% of cases; ARVC and left ventricular fibrosis most strongly predicted SCD during exertion. Conclusions Conditions predisposing to SCD in sports demonstrate a significant age predilection. The strong association of ARVC and left ventricular fibrosis with exercise-induced SCD reinforces the need for early detection and abstinence from intense exercise. However, almost 40% of athletes die at rest, highlighting the need for complementary preventive strategies.
Brian W Nolan - One of the best experts on this subject based on the ideXlab platform.
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restenosis after carotid endarterectomy in a multicenter Regional Registry
Journal of Vascular Surgery, 2010Co-Authors: Philip P Goodney, Brian W Nolan, Jens Eldrupjorgensen, Donald S Likosky, Jack L CronenwettAbstract:Background Level I evidence shows conventional carotid endarterectomy (CEA) with patch angioplasty results in lower rates of restenosis. However, whether this information has affected practice patterns and outcomes in real-world vascular surgery settings is unclear. Methods Within the Vascular Study Group of New England (VSGNE), we studied 2981 patients undergoing 2981 first-time CEAs between January 1, 2003, and June 31, 2008. Rates of restenosis (defined by duplex ultrasound imaging at the 1-year follow-up) were estimated using life-table analysis. Cox proportional hazards models were used to identify multivariable predictors of postoperative restenosis ≤1 year. Results Across 58 surgeons and 11 hospitals, we studied 2611 conventional CEAs (88% of all CEAs) and 370 eversion CEAs (12% of all CEAs). Median follow-up was 12.8 months (range, 1-35 months). The proportion of conventional CEAs performed with patching increased from 87% to 96% ( P P P P P 80% (HR, 4.1; 95% CI, 1.4-11.5), and dialysis dependence (HR, 3.5; 95% CI, 1.2-9.8) were independently associated with a higher risk of an 80% to 100% restenosis. Of the 51 patients with 80% to 99% restenosis, 14 underwent reintervention ≤1 year, comprising 4 reoperations and 10 carotid artery stent procedures. Of the 15 patients with a carotid occlusion ≤1 year, transient ischemic attacks occurred in 2 and a disabling stroke in 1. Conclusions In our region, restenosis after CEA, especially clinically significant restenosis ≤1 year after surgery, decreased slightly over time. This improvement in outcome was associated with several factors, including an increase in patching after conventional CEA, a process of care that was studied and encouraged within our vascular study group. These results highlight the utility of Regional quality-improvement efforts in improving outcomes in vascular surgery.
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protamine reduces bleeding complications associated with carotid endarterectomy without increasing the risk of stroke
Journal of Vascular Surgery, 2009Co-Authors: David H Stone, Philip P Goodney, Brian W Nolan, Donald S Likosky, Andres Schanzer, Robert A Cambria, Daniel B Walsh, Jack L CronenwettAbstract:Objectives Controversy persists regarding the use of protamine during carotid endarterectomy (CEA) based on prior conflicting reports documenting both reduced bleeding as well as increased stroke risk. The purpose of this study was to determine the effect of protamine reversal of heparin anticoagulation on the outcome of CEA in a contemporary multistate Registry. Methods We reviewed a prospective Regional Registry of 4587 CEAs in 4311 patients performed by 66 surgeons from 11 centers in Northern New England from 2003-2008. Protamine use varied by surgeon (38% routine use, 44% rare use, 18% selective use). Endpoints were postoperative bleeding requiring reoperation as well as potential thrombotic complications, including stroke, death, and myocardial infarction (MI). Predictors of endpoints were determined by multivariate logistic regression after associated variables were identified by univariate analysis. Results Of the 4587 CEAs performed, 46% utilized protamine, while 54% did not. Fourteen patients (0.64%) in the protamine-treated group required reoperation for bleeding compared with 42 patients (1.66%) in the untreated cohort (P = .001). Protamine use did not affect the rate of MI (1.1% vs 0.91%, P = .51), stroke (0.78% vs 1.15%, P = .2), or death (0.23% vs 0.32%, P = .57) between treated and untreated patients, respectively. By multivariate analysis, protamine (odds ratio [OR] 0.32, 95% confidence interval [CI], 0.17-0.63; P = .001) and patch angioplasty (OR 0.46, 95% CI, 0.26-0.81; P = .007) were independently associated with diminished reoperation for bleeding. A single center was associated with a significantly higher rate of reoperation for bleeding (OR 6.47, 95% CI, 3.02-13.9; P Conclusion Protamine reduced serious bleeding requiring reoperation during CEA without increasing the risk of MI, stroke, or death, in this large, contemporary Registry. In light of significant complications referable to bleeding, liberal use of protamine during CEA appears warranted.
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a Regional Registry for quality assurance and improvement the vascular study group of northern new england vsgnne
Journal of Vascular Surgery, 2007Co-Authors: Jack L Cronenwett, Jens Eldrupjorgensen, Donald S Likosky, Margaret T Russell, Andrew C Stanley, Brian W NolanAbstract:Objective A Regional cooperative data Registry was organized for carotid endarterectomy (CEA), lower extremity bypass (LEB), and infrarenal abdominal aortic aneurysm (AAA) repair (open and endovascular) procedures in Northern New England to allow benchmarking among centers for quality assurance and improvement activities. Methods Since January 2003, 48 vascular surgeons from nine hospitals in Maine, New Hampshire, and Vermont (25 to 615 beds) have prospectively recorded patient, procedure, and in-hospital patient outcome data. Results plus 1-year follow-up data analyzed at a central site are reported anonymously to each center at semiannual meetings where care processes and Regional benchmarks are discussed. Mortality and compliance with procedure entry were validated by independent comparison with hospital administrative data. Initial improvement efforts focused on optimizing preoperative medication usage. Results A total of 6143 operations were entered into the Registry through December 2006. In-hospital stroke or death after CEA was 1.0%, major amputation or death after LEB was 3.8%, and mortality was 2.9% after elective open and 0.4% after endovascular repair. Variation in results between centers and surgeons provides opportunity for further quality improvement. Any postoperative complication increased median length of stay by ≥3 days. Process improvement efforts initiated in 2004 increased preoperative β-blocker administration from 72% to 91%, antiplatelet agents from 73% to 83%, and statins from 54% to 72% (all P Conclusion This validated Regional data Registry within a quality improvement initiative has been associated with improved preoperative medication usage. It provides a potential vehicle for future public and pay-for-performance reporting and has the potential to improve patient outcomes. It has been sustained for >4 years and is a model that could be adopted by other regions.
Mary N Sheppard - One of the best experts on this subject based on the ideXlab platform.
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24 anomalous coronary artery origin and sudden cardiac death data from a large Regional Registry
Heart, 2018Co-Authors: Gherardo Finocchiaro, Michael Papadakis, Harshil Dhutia, Maite Tome, Elijah R Behr, Gaia Tanzarella, Igor Diemberger, Sanjay Sharma, Mary N SheppardAbstract:Background and aims Anomalous origin of a coronary artery (AOCA) from the inappropriate sinus of Valsalva or from the pulmonary artery is increasingly diagnosed with current imaging techniques. Although most AOCA subtypes are benign, they can rarely cause sudden cardiac death (SCD). The aim of the study was to describe the clinical and pathological features of AOCA in SCD victims. Methods We reviewed a database of 5100 consecutive cases of SCDs referred to our specialist cardiac pathology centre between 1994 and March 2017 and identified a subgroup of 30 (0.6%) cases with AOCA. All cases underwent detailed post-mortem evaluation including histological analysis by an expert cardiac pathologist. Clinical information was obtained from referring coroners. Results The mean age was 28±16 years and 23 individuals were males (77%). In 8 (27%) cases SCD occurred before 18 years of age. Cardiac symptoms were present in 11 (37%) individuals and syncope was the most common (n=6, 20%). The mean heart weight was 367±115 g. The most common anomalies were anomalous left coronary artery arising from the right sinus of Valsalva (ALCA) with inter-arterial course (n=11) and anomalous right coronary artery arising from the left sinus of Valsalva (ARCA) with inter-arterial course (n=11). Anomalous left coronary artery arising from pulmonary artery (ALCAPA) was present in 7 cases, while in 1 case the LCA arose from the non-coronaric cusp. Death occurred during exercise in 14 (47%) cases. The AOCA variant where death occurred more frequently during physical activity was ALCA (7/11, 64%), followed by ALCAPA (4/7, 57%) and ARCA (2/11, 18%). Conclusions AOCA is a rare cause of SCD. Anomalous left or right coronary artery arising from the wrong sinus of Valsalva with inter-arterial course is the most common anatomical variant recognised at the post-mortem of SCD victims. While in ALCA death is commonly associated with exercise, in ARCA death occurs usually during rest or sleep.