Doctors and paramedics spent 40 minutes trying to save the late Sopranos star James Gandolfini, a hospital spokesman has said.
The actor was found in the bathroom of his Rome hotel room before he was taken to the Policlinico Umberto I hospital.
Dr Claudio Modini told Reuters that as attempts to resuscitate Gandolfini in the ambulance and hospital had failed, he was considered dead on arrival.
Results of a post-mortem examination are expected on Friday.
"The resuscitation manoeuvres, including heart massage, continued for 40 minutes and then, seeing no electric activity from the heart, this was interrupted and we declared James dead," Dr Modini said.
Under Italian law, medical examiners are required to conduct a post-mortem 24 hours after the body's arrival in the morgue.
The actor died while on holiday in Italy, where he had been due to receive an honorary award at the Taormina Film Festival in Sicily and teach a masterclass.
Festival organisers Mario Sesti and Tiziana Rocca said they were "deeply saddened" by Gandolfini's death.
"We had heard from James Gandolfini a few hours before and he was very happy to receive this award and to be able to travel to Italy," they said in a statement.
"He was the American actor that better than anyone else has been able to interpret the Italian-American with his personality full of contrasts, ambition, pain, humour. He was the face of the golden age of television, but also a memorable film actor."
They added they would be organising a tribute to his "career and talent".
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Brad Pitt: "I'm going to miss him dearly and I just wish his family some strength"
Meanwhile, Hollywood stars have continued to pay tribute to the actor.
Kathryn Bigelow, who directed Gandolfini in Zero Dark Thirty, said she was devastated by the news.
"James was such an enormous talent, and an even greater spirit. I will be forever grateful for the privilege of working with him, and shall cherish his memories always," she said.
Brad Pitt, who appeared in three films with Gandolfini, called him "a ferocious actor" and said he was "gutted by this loss".
At the time of his death, the actor had been working on upcoming HBO series Criminal Justice, and had two films due out next year - the comedy Enough Said and crime drama Animal Rescue.
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