Incidence of cardiovascular sudden deaths in Minnesota high school athletes

Background: Sudden death (SD) in young competitive athletes due to cardiovascular disease is an important community issue with relevance to designing effective screening initiatives. However, the frequency with which these tragic events occur importantly affects considerations for selecting the most appropriate screening strategy.

Objective: To determine the incidence and causes of cardiovascular SDs in Minnesota high school athletes.

Methods: The forensic case records of the US National Registry of Sudden Death in Athletes were interrogated to identify those events judged to be cardiovascular in origin, occurring in organized competitive interscholastic sports participants.

Results: Over the 26-year period, 1986-2011, 13 SDs occurred in high school student-athletes related to physical exertion, during competition (n = 7) or at practice (n = 6). Ages were 12-18 years (median 16 years); each was a white man. Most common sports involved were basketball, wrestling, or cross-country running. Forensic examination found cardiac causes in 7: hypertrophic cardiomyopathy (in 2), anomalous coronary artery (2), myocarditis (1), aortic stenosis (1), and arrhythmogenic right ventricular cardiomyopathy (1); 4 had structurally normal hearts (with negative toxicity). There were 4,440,161 sports participations, including 1,930,504 individual participants among 24 sports. SD risk was 1:341,551 participations and 148,500 participants/academic year (0.7/100,000 person-years). In only 4 (31%) athletes could the responsible cardiovascular diseases have been reliably detected by screening with history/physical examination or 12-lead electrocardiogram, equivalent to 1:1,000,000 participations (2:1,000,000 participants/year).

Conclusions: In this high school athlete population, risk of cardiovascular SD was small, in the range of 1:150,000 participants/year. Based on autopsy data, only about 30% of the SDs were due to diseases that could be reliably detected by preparticipation screening, even with 12-lead electrocardiograms.