Objective To investigate the aetiology and incidence of sudden cardiac arrest and death (SCA/D) in US competitive athletes. Methods Prospective surveillance was conducted from 1 July 2014 to 30 June 2018 through the National Center for Catastrophic Sports Injury Research in collaboration with national sports organisations. Autopsy reports, death certificates, and medical records were reviewed by an expert panel to determine aetiology. Athlete participation statistics from the National Federation of State High School Associations and the National Collegiate Athletic Association (NCAA) were used to calculate incidence rates per athlete-years (AY). Comparisons of incidence rates were calculated using incidence rate ratios (IRR) with 95% CIs. Results 331 cases of confirmed SCA/D (158 survivors; 173 fatalities) were identified; 15.4% in middle school, 61.6% in high school and 16.6% in college and professional athletes. Average age was 16.7 (11–29) years, and the majority were in male (83.7%), basketball (28.7%) or American football (25.4%) athletes. Common causes included hypertrophic cardiomyopathy (20.6%), idiopathic left ventricular hypertrophy (13.4%), coronary artery anomalies (12.0%) and autopsy-negative sudden unexplained death (9.6%). Coronary anomalies were more common in middle school athletes (28%), while cardiomyopathies (hypertrophic, arrhythmogenic, dilated, non-compaction or restricted) accounted for 47% of cases in college and professional athletes. Incidence was higher in male versus female athletes at the high school (1:43 932 AY (95% CI 1:38 101 to 1:50 907) vs 1:203 786 AY (95% CI 1:145 251 to 1:293 794); IRR 4.6 (95% CI 3.1 to 7.2)) and NCAA (1:34 906 AY (95% CI 1:25 385 to 1:49 173) vs 1:123 278 AY (95% CI 1:66 078 to 1:249 853); IRR 3.5 (95% CI 1.5 to 9.5)) levels. African American male NCAA Division I basketball players had the highest annual incidence rate of SCA/D (1:2087 AY (95% CI 1:1073 to 1:4 450)). Conclusions Cardiomyopathies account for nearly half of SCA/D cases in college and professional athletes, while coronary artery anomalies play a more prominent role than expected in middle school athletes. Over half of SCA cases in athletes result in sudden death, calling for improved prevention strategies. All data relevant to the study are included in the article or uploaded as online supplemental information.

中文翻译：

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美国年轻竞技运动员心脏骤停和死亡的病因和发病率：一项为期 4 年的前瞻性研究

目的探讨美国竞技运动员心脏骤停猝死（SCA/D）的病因及发生率。方法 在 2014 年 7 月 1 日至 2018 年 6 月 30 日期间，通过国家灾难性运动损伤研究中心与国家体育组织合作进行了前瞻性监测。尸检报告、死亡证明和医疗记录由专家小组审查以确定病因。来自全国州立高中协会联合会和全国大学体育协会 (NCAA) 的运动员参与统计数据用于计算每运动员年 (AY) 的发病率。使用发生率比 (IRR) 和 95% CI 计算发生率的比较。结果 确诊 SCA/D 病例 331 例（幸存者 158 例；死亡 173 例）；15.4% 在中学，高中为 61.6%，大学和职业运动员为 16.6%。平均年龄为 16.7 (11-29) 岁，大多数为男性 (83.7%)、篮球 (28.7%) 或美式橄榄球 (25.4%) 运动员。常见原因包括肥厚型心肌病 (20.6%)、特发性左心室肥厚 (13.4%)、冠状动脉异常 (12.0%) 和尸检阴性的不明原因猝死 (9.6%)。冠状动脉异常在中学运动员中更为常见（28%），而心肌病（肥厚性、致心律失常性、扩张性、非致密性或受限）在大学和职业运动员中占 47%。高中男运动员的发病率高于女运动员（1:43 932 AY (95% CI 1:38 101 to 1:50 907) vs 1:203 786 AY (95% CI 1:145 251 to 1:293) 794）；IRR 4.6（95% CI 3.1 至 7.2））和 NCAA（1:34 906 AY（95% CI 1：25 385 至 1:49 173) 与 1:123 278 AY（95% CI 1:66 078 至 1:249 853）；IRR 3.5（95% CI 1.5 至 9.5））水平。非裔美国男性 NCAA I 级篮球运动员的 SCA/D 年发病率最高（1:2087 AY（95% CI 1:1073 至 1:4 450））。结论 心肌病占大学生和职业运动员 SCA/D 病例的近一半，而冠状动脉异常在中学运动员中的作用比预期更为突出。超过一半的运动员 SCA 病例导致猝死，需要改进预防策略。与研究相关的所有数据都包含在文章中或作为在线补充信息上传。非裔美国男性 NCAA I 级篮球运动员的 SCA/D 年发病率最高（1:2087 AY（95% CI 1:1073 至 1:4 450））。结论 心肌病占大学生和职业运动员 SCA/D 病例的近一半，而冠状动脉异常在中学运动员中的作用比预期更为突出。超过一半的运动员 SCA 病例导致猝死，需要改进预防策略。与研究相关的所有数据都包含在文章中或作为在线补充信息上传。非裔美国男性 NCAA I 级篮球运动员的 SCA/D 年发病率最高（1:2087 AY（95% CI 1:1073 至 1:4 450））。结论 心肌病占大学生和职业运动员 SCA/D 病例的近一半，而冠状动脉异常在中学运动员中的作用比预期更为突出。超过一半的运动员 SCA 病例导致猝死，需要改进预防策略。与研究相关的所有数据都包含在文章中或作为在线补充信息上传。超过一半的运动员 SCA 病例导致猝死，需要改进预防策略。与研究相关的所有数据都包含在文章中或作为在线补充信息上传。超过一半的运动员 SCA 病例导致猝死，需要改进预防策略。与研究相关的所有数据都包含在文章中或作为在线补充信息上传。