Troponin Clues: An Academic Reappraisal of Cardiac and Coronary Artery Pathologies in Sudden Death among Medicolegal Autopsies

Introduction: Sudden cardiac death (SCD) accounts for an estimated 15% to 20% of all deaths globally and is a leading cause of mortality. Methods: A cross-sectional study over 1-year (2023) recruiting medicolegal autopsy cases that were conducted in the Department of Forensic Medicine, Hospital Sultanah Aminah Johor Bahru (HSAJB), Malaysia. The relationship between point-of-care troponin I level and myocardial infarction (MI) was analysed. The morphology of the heart and coronary artery in cardiac death was also recorded. Results: A total of 143 cases were analyzed. Cardiac death was responsible for 78.2% of SCD. The leading cause of cardiac death was coronary atherosclerosis (31.1%). Significant association was demonstrated between SCD and the age group of 36–59 years old (p<0.001) and Malay ethnicity (p=0.017). No significant association between SCD and sex. Notably, a significant difference in troponin I levels between MI and non-MI cases (p=0.004), with the majority of MI cases (71.7%) showing elevated troponin I levels. No significant difference was observed in troponin I levels between acute and subacute and healed MI (p=0.763). The most common gross and histopathological finding in the coronary arteries was uncomplicated coronary atherosclerosis (41.3% gross; 70.0% histopathology). Fibrosis was the predominant macroscopic (50.8%) and microscopic (82.0%) finding in the heart. Conclusion: Coronary atherosclerosis and its complications were identified as the most common causes of cardiac death. It is plausible to consider using troponin I as an auxiliary investigation rather than as a sole diagnostic tool for MI, while exercising caution during the interpretation of results.