Cardiac Arrest during Long-Distance Running Races[1]
Summary
The RACER registry identified every cardiac arrest occurring during or within one hour of finishing US marathons and half-marathons from January 2000 to May 2010 — 59 arrests among 10.9 million registered participants (incidence 0.54/100,000; 1 per 184,000). Incidence was higher in marathons than half-marathons (1.01 vs 0.27/100,000) and in men than women (0.90 vs 0.16); male marathoners were the highest-risk group at 1.41/100,000, with incidence rising over the decade. Case fatality was 71% (42/59). Among fully characterized deaths, definite or possible hypertrophic cardiomyopathy was the leading cause; among survivors, ischemic heart disease dominated — with no angiographic plaque rupture found, suggesting demand ischemia. Younger age predicted death; survival was 47% in those ≥40 versus 7% under 40.
Key findings
- 59 arrests / 10.9 million participants (2000–2010): 0.54/100,000 overall; 1 per 184,000.
- Marathon 1.01 vs half-marathon 0.27 per 100,000; men 0.90 vs women 0.16; male marathoners 1.41 (rising 0.71→2.03 across the decade).
- Case fatality 71%; sudden-death incidence 0.39/100,000 (1 per 259,000).
- Leading cause of death: definite/possible HCM; survivors predominantly ischemic disease WITHOUT plaque rupture (demand ischemia).
- Bystander CPR and a non-HCM diagnosis were the strongest survival predictors.
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