| Summary: | Abstract Sudden cardiac death (SCD) remains a major health problem worldwide, and a great proportion of victims do not have a previously diagnosed heart disease. Especially in older population, the majority of SCDs are caused by coronary artery disease (CAD); however, the burden of CAD among the young has also been noted. The aim of this thesis was to study the characteristics of SCDs associated with CAD, especially in younger victims and in those with no prior history of heart disease. The study population consisted of 5,869 SCD victims from Northern Finland who underwent medicolegal autopsy between the years 1998–2017. In Study I, CAD was found to be the most common cause of SCD. At autopsies, a prior silent myocardial infarction (SMI) was detected in about 42% of the victims without a clinical history of CAD, and it was associated with myocardial hypertrophy and SCD during physical activity. A prior electrocardiogram was abnormal in 67% of the SCD victims with a previous SMI. In Study II, 10% of the study population were found to be aged under 50 years and the most common cause of SCD among these young SCD victims was CAD. In about 90% of the cases SCD occurred in the absence of previously diagnosed CAD, but at least one known cardiovascular risk factor was present in over half of the victims. Despite the young age, advanced heart disease was a common finding at autopsies. In Study III, the genetic background of cardiac hypertrophy was investigated in SCD victims with single-vessel CAD without a previously diagnosed heart disease. Possible disease-causing variants were detected in 8% of the study victims, while variants of uncertain significance existed in about 40% of the study victims. All detected variants were in myocardial structure protein coding genes. In Study IV, temporal trends in the incidence and characteristics of SCDs were studied in subjects under 40 years of age. The incidence of SCD decreased during the years 1998–2017. Most SCDs in this age group were due to non-ischemic myocardial diseases, ...
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