Sports Cardiology Program, Knight Cardiovascular Institute, Oregon Health and Science University, Portland (B.J.P.).
Division of Cardiology (B.J.P., T.W.C., A.L.B.), Massachusetts General Hospital, Boston.
Circulation. 2024 Jan 9;149(2):80-90. doi: 10.1161/CIRCULATIONAHA.123.065908. Epub 2023 Nov 13.
Understanding the incidence, causes, and trends of sudden cardiac death (SCD) among young competitive athletes is critical to inform preventive policies.
This study included National Collegiate Athletic Association athlete deaths during a 20-year time frame (July 1, 2002, through June 30, 2022). Athlete deaths were identified through 4 separate independent databases and search strategies (National Collegiate Athletic Association resolutions list, Parent Heart Watch database and media reports, National Center for Catastrophic Sports Injury Research database, and insurance claims). Autopsy reports and medical history were reviewed by an expert panel to adjudicate causes of SCD.
A total of 143 SCD cases in National Collegiate Athletic Association athletes were identified from 1102 total deaths. The National Collegiate Athletic Association resolutions list identified 117 of 143 (82%), the Parent Heart Watch database or media reports identified 89 of 143 (62%), the National Center for Catastrophic Sports Injury Research database identified 63 of 143 (44%), and insurance claims identified 27 of 143 (19%) SCD cases. The overall incidence of SCD was 1:63 682 athlete-years (95% CI, 1:54 065-1:75 010). Incidence was higher in male athletes than in female athletes (1:43 348 [95% CI, 1:36 228-1:51 867] versus 1:164 504 [95% CI, 1:110 552-1:244 787] athlete-years, respectively) and Black athletes compared with White athletes (1:26 704 [1:20 417-1:34 925] versus 1:74 581 [1:60 247-1:92 326] athlete-years, respectively). The highest incidence of SCD was among Division I male basketball players (1:8188 [White, 1:5848; Black, 1:7696 athlete-years]). The incidence rate for SCD decreased over the study period (5-year incidence rate ratio, 0.71 [95% CI, 0.61-0.82]), whereas the rate of noncardiovascular deaths remained stable (5-year incidence rate ratio, 0.98 [95% CI, 0.94-1.04]). Autopsy-negative sudden unexplained death (19.5%) was the most common postmortem examination finding, followed by idiopathic left ventricular hypertrophy or possible cardiomyopathy (16.9%) and hypertrophic cardiomyopathy (12.7%), in cases with enough information for adjudication (118 of 143). Eight cases of death were attributable to myocarditis over the study period (1 case from January 1, 2020, through June 30, 2022), with none attributed to COVID-19 infection. SCD events were exertional in 50% of cases. Exertional SCD was more common among those with coronary artery anomalies (100%) and arrhythmogenic cardiomyopathy (83%).
The incidence of SCD in college athletes has decreased. Male sex, Black race, and basketball are associated with a higher incidence of SCD.
了解年轻竞技运动员心源性猝死（SCD）的发生率、原因和趋势对于制定预防政策至关重要。
本研究纳入了 20 年时间内（2002 年 7 月 1 日至 2022 年 6 月 30 日）美国全国大学生体育协会（National Collegiate Athletic Association，NCAA）运动员的死亡情况。通过 4 个独立的数据库和搜索策略（NCAA 决议清单、家长心脏观察数据库和媒体报道、国家灾难性运动伤害研究中心数据库和保险索赔）确定运动员的死亡情况。对尸检报告和病史进行专家小组审查，以判断 SCD 的原因。
从 1102 例死亡中，共确定了 143 例 NCAA 运动员 SCD 病例。NCAA 决议清单确定了 117 例（82%），家长心脏观察数据库或媒体报道确定了 89 例（62%），国家灾难性运动伤害研究中心数据库确定了 63 例（44%），保险索赔确定了 27 例（19%）SCD 病例。总的 SCD 发生率为 1:63682 名运动员-年（95%置信区间：1:54065-1:75010）。男性运动员的发生率高于女性运动员（1:43348[95%置信区间：1:36228-1:51867]比 1:164504[95%置信区间：1:110552-1:244787]运动员-年，分别）和黑种人运动员比白种人运动员（1:26704[1:20417-1:34925]比 1:74581[1:60247-1:92326]运动员-年，分别）。SCD 发生率最高的是一级男性篮球运动员（1:8188[白人：1:5848；黑人：1:7696 运动员-年]）。在研究期间，SCD 的发病率呈下降趋势（5 年发病率比值比，0.71[95%置信区间：0.61-0.82]），而非心血管死亡的比率保持稳定（5 年发病率比值比，0.98[95%置信区间：0.94-1.04]）。尸检阴性的不明原因猝死（19.5%）是最常见的尸检发现，其次是特发性左心室肥厚或可能的心肌病（16.9%）和肥厚型心肌病（12.7%），在有足够信息进行裁决的病例中（143 例中的 118 例）。研究期间有 8 例死亡归因于心肌炎（1 例发生于 2020 年 1 月 1 日至 2022 年 6 月 30 日），无归因于 COVID-19 感染。SCD 事件与运动有关，占 50%。在具有冠状动脉异常（100%）和致心律失常性心肌病（83%）的患者中，运动性 SCD 更为常见。
大学运动员 SCD 的发生率有所下降。男性、黑种人、篮球与 SCD 发生率较高相关。
