Coronary artery disease underlies most sports-related sudden cardiac arrest in the general population

Abstract

Existing studies on sports-related sudden cardiac arrest (SCA) have focused principally on young competitive athletes. There is limited information on sports-related SCA in the general population. We sought to determine the burden, characteristics and etiology of SCA during sports activity in adults. Cases occurring during sports activity were compared to those unrelated to sports regarding characteristics and previous medical history. All cases of SCA occurring in the area (6.6 million inhabitants) were prospectively ascertained over a five-year period in this ongoing multicentre study. Data from all SCA during sports activity in either a competitive or recreational setting were analyzed. From May 2011 to May 2016, 3028 patients fulfilling criteria for SCA were admitted alive to hospital. Out of these, 138 (4.6%) SCA occurred during sports. The 3 most common sport activities during the SCA event were running (34.5%), cycling (14.4%) and soccer (8.6%). Sports-related SCA cases were younger (mean age: 52.7 ± 15.6 vs. 59.6 ± 15.6 years old, P < 0.001), more likely to be male (90.6 vs. 71.9%, P < 0.001), had lower cardiovascular risk factors (≥ 1 CVRF, 72.1 vs. 81.4%, P = 0.012), higher rate of bystander cardiopulmonary resuscitation (84.1 vs. 62.9%, P < 0.001) and higher proportion of ventricular fibrillation at EMS arrival (73.9 vs. 51.1%, P < 0.001) compared to other SCA. Among cases admitted alive to hospital with identified cause of SCA (71%), coronary artery disease (72.4%) was the main cardiovascular abnormality identified, mostly acute coronary syndrome (62.2%). Prior to SCA event, 22 cases (15.9%) were known to have heart disease, including CAD (5.8%) and 77 (66.4%) others presented with ≥ 1 CVRF. SCA during sports mostly concerns middle-aged men, with CAD being the frequent underlying cause (up to 75%). These results provide information to enhance sport preparticipation screening.