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Preparticipation Cardiac Screening Reduced Sudden Cardiac Deaths in Italian Athletes

Incidence rates declined after implementation of a preparticipation screening program that included routine ECGs.

In 1982, Italy launched a nationwide preparticipation cardiology screening program for young athletes aged 12 to 35 years that included a personal and family history, physical examination, and a 12-lead electrocardiogram (ECG). Further tests were ordered if risk factors or an abnormal ECG was identified. The rate of sudden cardiac death was compared for screened athletes and unscreened nonathletes during prescreening (1979–1981), early screening (1982–1992), and late screening (1993–2004).

During the study periods, 50 male and 5 female athletes experienced sudden cardiac death. The annual incidence of sudden cardiac death in athletes decreased from 3.6 per 100,000 person-years during prescreening to 0.4 per 100,000 person-years during late screening. In contrast, the incidence in unscreened nonathletes remained constant at 1.9 per 100,000 person-years. Compared with the incidence of sudden cardiac death during the prescreening period, the relative risk for sudden death in athletes was 0.56 in the early screening period and 0.21 in the late screening period. Fewer cases of sudden cardiac death from cardiomyopathy accounted for most of the reduced mortality; however, cardiomyopathies also were the most common cause of sudden cardiac death (25%).

Comment: In this Italian population, routine screening with ECG for participation in competitive sports was associated with a dramatic reduction in sudden cardiac death. Editorialists note that the incidence of sudden cardiac death during the final late screening period is similar to the current death rate for young U.S. athletes without routine ECG screening. They present a convincing argument that ECG is not yet justified for preparticipation screening in the U.S.

— F. Bruder Stapleton, MD

Published in Journal Watch Pediatrics and Adolescent Medicine November 29, 2006

Citation(s):

Corrado D et al. Trends in sudden cardiovascular death in young competitive athletes after implementation of a preparticipation screening program. JAMA 2006 Oct 4; 296:1593-601.

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• Medline abstract (Free)

Thompson PD and Levine BD. Protecting athletes from sudden cardiac death. JAMA 2006 Oct 4; 296:1648-50.

• Original article (Subscription may be required)
• Medline abstract (Free)