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Acute CV events during endurance races rare, but unpredictable
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Acute MI and other life-threatening CV events during endurance races are rare, but because of the unpredictability of such events, more refined risk stratification is needed, researchers reported in the European Heart Journal.
Benoît Gérardin, MD, of Surgical Center Marie Lannelongue in France, and colleagues conducted a retrospective analysis of the RACE Paris registry to determine the incidence and etiology of life-threatening events that occurred during long-distance races in Paris between October 2006 and September 2012. This included the Paris marathon and half-marathon, the Boulogne-Billancourt half-marathon, the 20 km de Paris and the Paris–Versailles.
The primary endpoint was a composite of any death or any life-threatening events requiring onsite and hospital medical intervention 30 minutes before or within 2 hours after the race.
Gérardin and colleagues identified 17 life-threatening events among 511,880 runners, two of which were fatal. Thirteen of those events were CV-related and occurred predominately in seasoned male runners (mean age, 43 10 years) with infrequent CV risk factors who had experienced atypical warning symptoms before the race. Eight runners experienced acute MI requiring immediate revascularization. According to study findings, all runners with initial shockable rhythm survived.
Meta-analysis of the six studies in the registry revealed a low prevalence of life-threatening events (0.75/100,000), but also an association between nonshockable rhythm (OR = 29.9; 95% CI, 4-222.5) and nonischemic etiology (OR = 6.4; 95% CI, 1.4-28.8) with runner fatality.
Unlike previous reports of a less than 20% survival rate after cardiac arrest during a sport event, unsuccessful resuscitation during the RACE Paris registry only occurred twice.
According to Gérardin and colleagues, the poor predictability of these life-threatening events must be investigated further. Only two of the 17 events could have been avoided, one from exertional heat stroke and one acute MI in which the runner experienced stress angina before the race, they wrote.
The findings of this registry “confirm the very low prevalence of life-threatening events during endurance race[s],” the researchers concluded. They noted that the “absolute number of life-threatening events in the RACE Paris Registry is low but the event rate is among the highest ever reported.” However, “this is accounted for by the design of the RACE Paris Registry,” the researchers wrote. – by Tracey Romero
Disclosure: The researchers report no relevant financial disclosures.
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