Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
N Engl J Med. 2012 Jan 12;366(2):130-40. doi: 10.1056/NEJMoa1106468.
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.
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.
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.
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.
每年约有 200 万人参加美国的长跑比赛。与比赛相关的心脏骤停报告引起了人们对该活动安全性的关注。
我们评估了 2000 年 1 月 1 日至 2010 年 5 月 31 日期间美国马拉松和半程马拉松比赛中与比赛相关的心脏骤停的发生率和结局。我们通过采访幸存者和非幸存者的近亲、审查病历和分析尸检数据来确定心脏骤停的临床特征。
在 1090 万名跑步者中，有 59 人（平均年龄[±标准差]42-13 岁；51 名男性）发生了心脏骤停（发生率为 0.54/100,000 参与者；95%置信区间[CI]，0.41 至 0.70）。心血管疾病是心脏骤停的主要原因。马拉松比赛的发生率（1.01/100,000；95%CI，0.72 至 1.38）明显高于半程马拉松比赛（0.27；95%CI，0.17 至 0.43）和男性（0.90/100,000；95%CI，0.67 至 1.18）高于女性（0.16；95%CI，0.07 至 0.31）。男性马拉松运动员是风险最高的群体，在研究的后半期，他们的心脏骤停发生率增加（2000-2004 年，0.71/100,000[95%CI，0.31 至 1.40]；2005-2010 年，2.03/100,000[95%CI，1.33 至 2.98]；P=0.01）。在 59 例心脏骤停中，有 42 例（71%）为致命性（发生率为 0.39/100,000；95%CI，0.28 至 0.52）。在 31 例具有完整临床数据的病例中，旁观者实施心肺复苏术和除肥厚型心肌病以外的基础诊断是存活的最强预测因素。
马拉松和半程马拉松与心脏骤停和猝死的总体风险较低相关。心脏骤停最常见的原因是肥厚型心肌病或动脉粥样硬化性冠状动脉疾病，主要发生在男性马拉松运动员中；在过去十年中，该组的发生率有所增加。
