Life-threatening events (LTE) during long-distance races are rare and survival is high, according to a study of the RACE Paris Registry of more than a million runners participating in half- or full-marathons, presented Sept. 2 at ESC Congress 2019.

Building on previous research from the registry with similar findings, Jean-Philippe Collet, MD, PhD, and colleagues found that air pollution (odds ratio, 3.27) and high temperatures (1.02 events per 100,000 participants) increased the risk of life-threatening events.

From a total of 1,073,722 runners who participated in 46 consecutive long-distance races in Paris between October 2006 and September 2016, researchers examined cases of participants who had an adverse event within 30 minutes before, during or within two hours after the end of a race. The primary endpoint was any death or LTE requiring urgent on-site medical intervention and hospital admission for at least 24 hours.

Of the 36 participants who had an LTE, 11 had exertional heat stroke and 25 had a major cardiovascular event. This translated to an event rate of 3.35 per 100,000 participants for an LTE, which were predominantly major cardiac events at a rate of 2.32 per 100,000 participants. The rate of sudden cardiac arrest was 1.67 per 100,00 participants. Mortality was low at just 0.19 per 100,000 participants, with a nonischemic etiology (cardiac arrest with ventricular fibrillation in 11/25) and asystole (chest pain in 5/25) as the major risk factors.

One-third of the patients who experienced an LTE (16/25 patients; 64 percent) had a history of myocardial ischemia. This was an acute coronary syndrome for 11 of the 25 participants). In terms of pre-race cardiac testing, 14/25 had an electrocardiogram and 8/25 had undergone cardiac testing. The most common treatment was PCI (in 14/25; 56 percent), and 23 of 23 patients (92 percent) were discharged alive.

The researchers noted that more than half of LTEs that occur during long-distance races can be prevented.

Keywords: ESC 19, ESC Congress, Sports, Death, Sudden, Cardiac

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