Pre-hospital phase characteristics of sport-related myocardial infarction: insights from a large multicentre regional survey

Background Coronary artery disease (CAD) including acute myocardial infarction (AMI) is the major cause of sport-related (SR) sudden cardiac arrest (CA). However, context and determinants of outcomes in SR-CA remain poorly explored. Purpose To identify opportunities for target prevention of such dramatic events, we aimed to analyse prevalence, characteristics and prehospital management of out of hospital cardiac arrest (OHCA) in SR-AMI. Methods From a large prospective multicentre regional survey (IMACS), all consecutive patients hospitalised for an SR-AMI, from April 1st 2018 to February 22nd 2023 were analysed, SR-AMI was defined as AMI occurrence during sport or at recovery (<1 hour after sport). Results Among the 140 patients with SR-AMI included, 13 (9.3%) were female, median age was 61-y (IQR 54-66), 16(11.4%) had prior CAD and 14 (10%) experienced an OHCA. The main sports were cycling (33.6%), fitness (12.1%), hiking (11.4%) and running (10.7%). Most SR-AMI occurred during exercise (60.7%) and were ST segment elevation myocardial infarction (STEMI) (67.4%). When compared with patients without CAD, CAD patients had the same age, similar rate of prodromal symptoms and bystander at MI symptom onset (Table). The rate of patients who performed an appropriate call to emergency medical services (EMS) was low and similar with or without history of CAD. Median time to EMS call was shorter in patients with prior CAD. OHCA were 4 times more common in patients with CAD (31.3% and 8.7%, respectively (p=0.011)). However, the time delay for EMS call was similar for the 2 groups in patients without OHCA (p = 0.630). Among OHCA in the absence of EMS (n=9), bystanders always performed cardiopulmonary resuscitation, while they used AED in only 2 events. Conclusions Our findings from a large regional survey identify specificities in the pre-hospital phase of SR-AMI. We showed a gap in opportunities for prevention and management of these dramatic events.