Abstract 9782: Sudden Death in U.S. College Athletes: Incidence, Causes, and Implications for Preparticipation Screening

Abstract

Introduction: Frequency with which cardiovascular-related sudden deaths (SD) occur in competitive athletes importantly impacts considerations for the most appropriate preparticipation screening strategy, particularly the potential value of incorporating the12-lead ECG. Hypothesis: Unsuspected cardiovascular disease may not be the predominant cause of sudden death in college athletes. Methods: We assessed databases (including autopsy reports) from both the U.S. National Sudden Death in Young Athletes Registry and National Collegiate Athletic Association (NCAA) (2002-2011) to define the incidence and causes of SD in college student-athletes. Results: Over the 10 year period, 182 SDs occurred (ages 20 ± 1.7; 85% males; 64% white): 52 resulting from suicide (n = 31) or drug abuse (n = 21), and 64 probably or likely attributable to cardiovascular causes. Of the 64 athletes, 47 had a confirmed post-mortem diagnosis, most commonly hypertrophic cardiomyopathy in 21, and congenital coronary anomalies in 8. The 4,052,369 athlete participations (in 30 sports over 10 years) incurred mortality risks of: suicide and drugs combined, 1.3/100,000 athlete participation-years (5 deaths/year); documented cardiovascular disease, 1.2/100,000 (4 deaths/year); and cardiovascular diseases judged reliably detectable by screening ECGs, 0.7/100,000 (2-3/year). Notably, cardiovascular deaths were significantly (5-fold) more common in African-American athletes than whites (3.8 vs. 0.7 100,000; p <0.01), but were less frequent in NCAA college athletes than in the general population of the same age (p < 0.01). Conclusions: In college student-athletes, SD risk due to cardiovascular disease is relatively low, with mortality rates similar to that of suicide and drug abuse, significantly less than expected in the general population, but highest in African-Americans. About 40% of confirmed cardiovascular deaths may not have been reliably detected by preparticipation screening, even with 12-lead ECGs.