Among long-distance runners, life-threatening events were rare (0.75/100,000), but presentation with a non-shockable rhythm was strongly associated with case-fatality (OR 29.9; 95% CI 4.0-222.5; P=0.001).
Observational (n=511,880)
What are the incidence, aetiology, and predictors of fatality for life-threatening events during long-distance running races?
Life-threatening events during long-distance races are rare and predominantly caused by acute myocardial ischaemia, with non-shockable rhythms and non-ischaemic aetiologies driving mortality.
Odds Ratio: 29.9 (95% CI 4–222.5)
p-value: p=0.001
AIM: Long distance running races are associated with a low risk of life-threatening events much often attributed to hypertrophic cardiomyopathy. However, retrospective analyses of aetiology lack consistency. METHODS AND RESULTS: Incidence and aetiology of life-threatening/fatal events were assessed in long distance races in the prospective Registre des Accidents Cardiaques lors des courses d'Endurance (RACE Paris Registry) from October 2006 to September 2012. Characteristics of life-threatening/fatal events were analysed by interviewing survivors and reviewing medical records including post-mortem data of each case. Seventeen life-threatening events were identified of 511 880 runners of which two were fatal. The vast majority were cardiovascular events (13/17) occurring in experienced male runners mean (±SD) age 43 ± 10 years, with infrequent cardiovascular risk factors, atypical warning symptoms prior to the race or negative treadmill test when performed. Acute myocardial ischaemia was the predominant aetiology (8 of 13) and led to immediate myocardial revascularization. All cases with initial shockable rhythm survived. There was no difference in event rate according to marathons vs. half-marathons and events were clustered at the end of the race. A meta-analysis of all available studies including the RACE Paris registry (n = 6) demonstrated a low prevalence of life-threatening events (0.75/100 000) and that presentation with non-shockable rhythm OR = 29.9; 95% CI (4.0-222.5), P = 0.001 or non-ischaemic aetiology OR = 6.4; 95% CI (1.4-28.8), P = 0.015 were associated with case-fatality. CONCLUSION: Life-threatening/fatal events during long distance races are rare, most often unpredictable and mainly due to acute myocardial ischaemia. Presentation with non-shockable rhythm and non-ischaemic aetiology are the major determinant of case fatality.
Gérardin et al. (Mon,) conducted a observational in Life-threatening or fatal cardiovascular events (n=511,880). Presentation with non-shockable rhythm vs. Presentation with shockable rhythm was evaluated on Case-fatality (OR 29.9, 95% CI 4.0-222.5, p=0.001). Among long-distance runners, life-threatening events were rare (0.75/100,000), but presentation with a non-shockable rhythm was strongly associated with case-fatality (OR 29.9; 95% CI 4.0-222.5; P=0.001).