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Sudden death among the Israeli civilian population during the Gulf War--incidence and mechanisms.

The Gulf War in January 1991 provided a unique opportunity to evaluate the influence of acute stress on the incidence of sudden cardiac death (SCD) in the Israeli civilian population. Pursuing this intriguing issue seemed warranted as we documented and reported a pronounced increase in the incidence of acute myocardial infarctions during that period. The purpose of the present study therefore was to document the incidence of SCD in different regions of Israel during a 10 day period preceding the Gulf War and a similar period following its onset, and to try to identify a possible correlation between the intensity of threat and the incidence of SCD. Sixty-eight cases during the Gulf War study period were compared to 213 cases in 5 control periods; overall 281 cases of SCD were documented. A rise in the incidence of SCD during the first 10 days of the war as compared to previous periods was noted but did not reach statistical significance. No correlation was demonstrated for SCD incidence among different regions in relation to the intensity of threat. Mechanisms by which acute stress precipitates an acute coronary syndrome are discussed, and an explanation for the lack of a statistically significant difference in SCD incidence is offered.