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Incidence and Causes of Sudden Cardiac Death in U.S. College Athletes
Study Questions:
What are the incidence and causes of death in college student-athletes?
Methods:
Databases (including autopsy reports) from both the US National Sudden Death in Athletes Registry and National Collegiate Athletic Association (NCAA) for 2002-2011 were assessed to define the incidence and causes of death in college student-athletes.
Results:
Over the 10-year period, 182 episodes of sudden death occurred (ages 20 ± 1.7; 85% males; 64% white): 52 resulted from suicide (n = 31) or drug abuse (n = 21), and 64 probably or likely were attributable to cardiovascular causes (6/year). Of the 64 athletes, 47 had a confirmed post-mortem diagnosis (four/ year), most commonly hypertrophic cardiomyopathy in 21, and congenital coronary anomalies in eight. The 4,052,369 athlete participations (in 30 sports over 10 years) incurred mortality risks of: suicide and drugs combined, 1.3/100,000 athlete-participation-years (five deaths/year); and documented cardiovascular disease, 1.2/100,000 (four deaths/year). Notably, cardiovascular deaths were fivefold more common in African-American athletes than whites (3.8 vs. 0.7/100,000, p < 0.01), but did not differ from the general population of the same age and race (p = 0.6).
Conclusions:
The authors concluded that, in college student-athletes, sudden death risk due to cardiovascular disease is relatively low, with mortality rates similar to suicide and drug abuse; and less than expected in the general population, although higher in African-Americans. The majority of underlying cardiac diseases that led to confirmed cardiovascular deaths likely would have been reliably detected by preparticipation screening with a 12-lead electrocardiogram (ECG).
Perspective:
Preparticipation screening for amateur high school and college athletes in the US typically involves a directed history and physical examination. In contrast, European Union (EU) and some other countries mandate a preparticipation screening ECG in an attempt to detect otherwise silent cardiovascular disease. A debate continues about the efficacy of preparticipation screening ECGs (issues include an ability to detect some but not all cardiac diseases that predispose for sudden death, and rates of false-positive ECGs that lead to additional testing), as well as the feasibility of transferring EU practice to the US (issues include relative prevalence of various cardiac diseases, and differences in medical-legal climates). This study is an extension of existing work using the US National Registry of Sudden Death that has been maintained at the Minneapolis Heart Institute since 1992, and it continues to suggest a low risk of sudden cardiac death among college athletes in the US. The low frequency of observed sudden cardiac death would tend to support the effectiveness of current screening practices (that do not include a routine ECG).
Keywords: Athletes, Cause of Death, Registries, Cardiomyopathy, Hypertrophic, Sports, Autopsy, Physical Examination, Death, Sudden, Cardiac, Substance-Related Disorders, United States, Suicide
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