I am a bit concerned because I plan to study the risk factors for developing fatal myocardial infarction (MI). As far I read, MI cases are identified in hospitals, and from death registers.

I am skeptic to the idea of using registers, because I have no idea how cases are identified outside the hospital wards. Clinicians in the hospital diagnose MI cases (fatal or not) with more rigorous criteria that people who died outside the hospital. People who died outside the hospital require an autopsy or at least a postmortem EKG that support their diagnoses.

I have legitimate concerns about case-control and cohort studies where fatal MI is studies. In all studies I've read composite outcomes like "sudden death" or "cardiovascular death" replace fatal MI. In an early paper from the 1979, 5% of medical examiners performed complete autopsy protocols to Framingham cohort members. I have not read any paper if the situation have changed!

Although, I agree that stroke might share some features with MI, I am not sure it is wise to continue doing so.

I am wondering which role might forensics or any other death authority investigating fatal MI and which challenges are required to accomplish such collaboration?