Cardiac Arrest during Long-Distance Running Races

Jonathan H. Kim, M.D., Rajeev Malhotra, M.D., George Chiampas, D.O., Pierre d'Hemecourt, M.D., Chris Troyanos, A.T.C., John Cianca, M.D., Rex N. Smith, M.D., Thomas J. Wang, M.D., William O. Roberts, M.D., Paul D. Thompson, M.D., and Aaron L. Baggish, M.D., for the Race Associated Cardiac Arrest Event Registry (RACER) Study Group

Journal: New England Journal of Medicine
DOI: 10.1056/NEJMoa1106468
Publication type: Research
Study type: registry study
Population: long-distance runners

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Abstract

Background
Approximately 2 million people participate in long-distance running races in the United States annually. Reports of race-related cardiac arrests have generated concern about the safety of this activity.

Methods
We assessed the incidence and outcomes of cardiac arrest associated with marathon and half-marathon races in the United States from January 1, 2000, to May 31, 2010. We determined the clinical characteristics of the arrests by interviewing survivors and the next of kin of nonsurvivors, reviewing medical records, and analyzing postmortem data.

Results
Of 10.9 million runners, 59 (mean [±SD] age, 42±13 years; 51 men) had cardiac arrest (incidence rate, 0.54 per 100,000 participants; 95% confidence interval [CI], 0.41 to 0.70). Cardiovascular disease accounted for the majority of cardiac arrests. The incidence rate was significantly higher during marathons (1.01 per 100,000; 95% CI, 0.72 to 1.38) than during half-marathons (0.27; 95% CI, 0.17 to 0.43) and among men (0.90 per 100,000; 95% CI, 0.67 to 1.18) than among women (0.16; 95% CI, 0.07 to 0.31). Male marathon runners, the highest-risk group, had an increased incidence of cardiac arrest during the latter half of the study decade (2000–2004, 0.71 per 100,000 [95% CI, 0.31 to 1.40]; 2005–2010, 2.03 per 100,000 [95% CI, 1.33 to 2.98]; P=0.01). Of the 59 cases of cardiac arrest, 42 (71%) were fatal (incidence, 0.39 per 100,000; 95% CI, 0.28 to 0.52). Among the 31 cases with complete clinical data, initiation of bystander-administered cardiopulmonary resuscitation and an underlying diagnosis other than hypertrophic cardiomyopathy were the strongest predictors of survival.

Conclusions
Marathons and half-marathons are associated with a low overall risk of cardiac arrest and sudden death. Cardiac arrest, most commonly attributable to hypertrophic cardiomyopathy or atherosclerotic coronary disease, occurs primarily among male marathon participants; the incidence rate in this group increased during the past decade.

Description

This study assesses cardiac arrest incidence in long-distance running races in the U.S. from 2000 to 2010.