Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 8: Coronary Artery Disease : A Scientific Statement from the American Heart Association and American College of Cardiology
- ACC/AHA Scientific Statements;
- coronary artery disease;
- sudden cardiac death
Atherosclerotic coronary artery disease (ASCAD) is the leading cause of sudden cardiac death (SCD) and acute myocardial infarction (AMI) in adult athletes, variously defined as people older than age 30, 35, or 40 years (1). ASCAD can occur in younger athletes who have inherited hyperlipidemia. For many adults, SCD or AMI is the first manifestation of ASCAD, because most of these acute events are caused by coronary plaque disruption and acute coronary thrombosis in plaques that were previously not sufficiently narrowed to have caused ischemia, even during intense exercise (1). There is universal agreement that vigorous exercise, such as athletic competition, acutely, albeit transiently, increases the risk of SCD and AMI in previously healthy people (1). Vigorous exercise also transiently increases the risk for SCD and AMI in people with diagnosed ASCAD. These events may be caused by plaque disruption, but SCD in these patients may also be produced by malignant arrhythmias caused by demand ischemia or originating in areas of myocardial scar (1). In addition to ASCAD, other coronary conditions such as coronary vasospasm, myocardial bridging, and coronary dissection, as well as infection such as Kawasaki disease, vasculitis, and cardiac transplant vasculopathy, may also cause acute cardiac events during exercise. The present section makes recommendations on how to evaluate patients with disease of the coronary arteries and make appropriate recommendations for athletic competition. Anomalous coronary arteries are considered in the Task Force 4 report (2).
We searched PubMed for English language articles reporting exercise-related issues related to coronary diseases. This search produced no clinical trials examining how competitive athletes with coronary artery diseases should be advised regarding vigorous exercise in general or athletic competition in particular. Consequently, the following recommendations are based on case series, case reports, and consensus among the committee members.
Autor / Fonte:Paul D Thompson, Robert J Myerburg, Benjamin D Levine, James E Udelson, Richard J Kovacs Journal of the American College of Cardiology 2015 October 27