Management of acute myocardial infarction occurring during sport practice: Contemporary data from the ‘obseRvatoire des Infarctus de Côte d’Or’ (RICO) survey

Abstract

Over the last decade, acute myocardial infarction (AMI) management has considerably evolved, but current management of sport-related AMI remains poorly investigated. We aimed to analyze the acute therapeutic strategies used in AMI occurring during sport activity. We retrospectively analyze consecutive patients from an AMI database (RICO survey) who underwent a coronary angiography (CA) in a university hospital after a sport-related AMI within 2011 to 2017 ( n = 100). Most were male (86%), with median age at 58 (50–67) y. Out-of-hospital sudden cardiac arrest (OHSCA) was experienced by 20%; at admission. At the acute phase, 3% underwent ECMO and 2% had an IABP. Intravenous fibrinolysis was given in 14% (26% of the 54 STEMI patients), successfully in 64%. CA was performed through a radial approach in 89%; OCT or IVUS was used in 2 patients. Thromboaspiration was performed in 30%, balloon predilatation in 26% and direct stenting in 73%. Most PCI were performed using drug eluting stent (DES) (69%) with 1 stent (78%), 2 stents (15%), 3 stents (7%) or no stent (5%). Median time from symptoms to reperfusion was 145 (105–228) and to PCI 163 (126–240) min. A re-intervention during hospitalization was performed in 20% of patients, with implantation of 1 stent (39%) 2 stents (35%), 3 stents (17%), 4 stents (4%); all stents but one were DES. Seven patients underwent CABG surgery in addition to PCI. No ICD was implanted. During hospitalization, 10 patients died (all initially presented with OHSCA); all victims treated with ECMO died and only one with IABP survived (used for management of early stent thrombosis). From this large series, thrombolysis was rare, but thromboaspiration was performed in nearly one third of patients; culprit lesions were often treated by direct stenting, with a DES in more than 2/3 of cases. A re-intervention procedure was often needed to treat other lesions, more often with DES rather than CABG.