Sudden cardiac arrest incidence was 16.9 per million in men and 5.7 in women during Paris endurance races, with 88% survival and high idiopathic cases.
Sudden cardiac arrest during endurance races is rare, predominantly affects men, often occurs in the final kilometers, and has a high survival rate with excellent neurological outcomes despite frequently being idiopathic.
Abstract Aims The rising popularity of endurance races underscores the need to explore the risks of sports-related sudden cardiac arrest (Sr-SCA). Although rare, Sr-SCA is significantly more prevalent in men than in women. The mechanisms underlying these sex differences remain unclear. We aimed to investigate the incidence rates, clinical characteristics, aetiologies, sex differences, and exercise performances among SCA cases during major endurance races in Paris over a 10-year period. Methods and results We Analysed the Paris Sudden Death Expertise Centre Registry Data (Covering 2011–2024, excluding 2020). This included SCA cases from the half marathon, full marathon and 20 km Parisian race events. We calculated the incidence rates for men and women, with performance analyses focusing on acceleration patterns and the relative risk of SCA in the final kilometre. Among the 1.2 million participants, 17 SCA cases (88% male) were identified, yielding crude incidences of 16.9 and 5.7 per million for men and women, respectively. Sr-SCA was overrepresented in the final kilometres of short races. Men exhibited twice the acceleration rate that women did. Despite extensive medical investigations, no cause was identified in 47.1% of the cases, underscoring the idiopathic nature of Sr-SCA. After hospitalization, 88% (15/17) of the cases survived, all with excellent neurological outcomes cerebral performance category (CPC) 1, except for one CPC 2. Conclusion SCA incidences during endurance races are low, with male predominance, high survival rates, and a high proportion of unexplained cases. The male-specific acceleration in the final kilometre may suggest that physiological and behavioural factors influence SCA risk.
Chocron et al. (2026) studied this question. Sudden cardiac arrest incidence was 16.9 per million in men and 5.7 in women during Paris endurance races, with 88% survival and high idiopathic cases.