MYOCARDIAL INFARCTION IN ATHLETES: EPIDEMIOLOGY, PATHOPHYSIOLOGICAL MECHANISMS, DIAGNOSTIC CHALLENGES, AND PREVENTIVE STRATEGIES
DOI:
https://doi.org/10.31435/ijitss.3(51).2026.6500Keywords:
Myocardial Infarction, Athletes, Sudden Cardiac Death, Sports Cardiology, Coronary Artery Anomalies, Preparticipation ScreeningAbstract
Myocardial infarction (MI) among athletes is an uncommon but clinically significant event that has attracted growing attention because of its potential to cause sudden cardiac death (SCD) and long-term morbidity in an otherwise healthy population. This review synthesizes current literature on the epidemiology, pathophysiology, diagnostic evaluation, and preventive strategies for MI in athletes across age groups. In athletes younger than approximately 35 years, MI is rare and is more often attributable to non-atherosclerotic mechanisms—congenital coronary artery anomalies, spontaneous coronary artery dissection, coronary artery spasm, myocardial bridging, an oxygen supply–demand mismatch related to hypertrophic cardiomyopathy, or performance-enhancing substance use—than to classic atherosclerotic coronary artery disease. In masters athletes, generally older than 35 years, atherosclerotic plaque rupture or erosion, frequently triggered by the acute hemodynamic stress of intense exertion, becomes the predominant mechanism. Preparticipation cardiovascular screening, incorporating structured history-taking, physical examination, and standardized electrocardiographic interpretation criteria, together with the widespread availability of automated external defibrillators and bystander cardiopulmonary resuscitation training, constitutes the principal preventive strategy, although its optimal design and cost-effectiveness remain debated. Following an acute event, individualized, shared-decision-making approaches to return-to-play balance the cardiovascular and psychological benefits of continued exercise against residual arrhythmic and ischemic risk. Continued research into advanced imaging biomarkers, genetic testing, and risk-stratification tools is needed to refine clinical care for this distinctive population.
References
Ferreira, M., Santos-Silva, P. R., de Abreu, L. C., Valenti, V. E., Crispim, V., Imaizumi, C., Ferreira Filho, C., Murad, N., Meneghini, A., Pérez Riera, A. R., de Carvalho, T. D., Vanderlei, L. C. M., Valenti, E. E., Cisternas, J. R., Moura Filho, O. F., & Ferreira, C. (2010). Sudden cardiac death athletes: A systematic review. BMC Sports Science, Medicine and Rehabilitation, 2, 19. https://doi.org/10.1186/1758-2555-2-19
Finocchiaro, G., Westaby, J., Sheppard, M. N., Papadakis, M., & Sharma, S. (2024). Sudden cardiac death in young athletes: JACC state-of-the-art review. Journal of the American College of Cardiology, 83(2), 350–370. https://doi.org/10.1016/j.jacc.2023.10.032
Han, J., Lalario, A., Merro, E., Sinagra, G., Sharma, S., Papadakis, M., & Finocchiaro, G. (2023). Sudden cardiac death in athletes: Facts and fallacies. Journal of Cardiovascular Development and Disease, 10(2), 68. https://doi.org/10.3390/jcdd10020068
Maron, B. J., Doerer, J. J., Haas, T. S., Tierney, D. M., & Mueller, F. O. (2009). Sudden deaths in young competitive athletes: Analysis of 1866 deaths in the united states, 1980–2006. Circulation, 119(8), 1085–1092. https://doi.org/10.1161/CIRCULATIONAHA.108.804617
de Noronha, S. V., Sharma, S., Papadakis, M., Desai, S., Whyte, G., & Sheppard, M. N. (2009). Aetiology of sudden cardiac death in athletes in the united kingdom: A pathological study. Heart, 95(17), 1409–1414. https://doi.org/10.1136/hrt.2009.168369
Maron, B. J., Poliac, L. C., & Roberts, W. O. (1996). Risk for sudden cardiac death associated with marathon running. Journal of the American College of Cardiology, 28(2), 428–431.
Maron, B. J., Araújo, C. G., Thompson, P. D., Fletcher, G. F., Bayés de Luna, A., Fleg, J. L., Pelliccia, A., Balady, G. J., Furlanello, F., Van Camp, S. P., Elosua, R., Chaitman, B. R., & Bazzarre, T. L. (2001). Recommendations for preparticipation screening and the assessment of cardiovascular disease in masters athletes: An advisory for healthcare professionals from the working groups of the world heart federation, the international federation of sports medicine, and the american heart association committee on exercise, cardiac rehabilitation, and prevention. Circulation, 103(2), 327–334. https://doi.org/10.1161/01.CIR.103.2.327
Boarescu, I., & Boarescu, P.-M. (2024). Drug-induced myocardial infarction: A review of pharmacological triggers and pathophysiological mechanisms. Journal of Cardiovascular Development and Disease, 11(12), 406. https://doi.org/10.3390/jcdd11120406
Dotka, M., & Małek, Ł. A. (2023). Myocardial infarction in young athletes. Diagnostics, 13(15), 2473. https://doi.org/10.3390/diagnostics13152473
Zeppilli, P., Bianco, M., Gervasi, S. F., Cammarano, M., Monti, R., Sollazzo, F., Modica, G., Morra, L., Nifosì, F. M., & Palmieri, V. (2023). Congenital coronary artery anomalies in sports medicine: Why to know them. Clinical Cardiology, 46(9), 1038–1048. https://doi.org/10.1002/clc.24084
Compagnucci, P., Volpato, G., Falanga, U., Cipolletta, L., Conti, M. A., Grifoni, G., Ciliberti, G., Stronati, G., Fogante, M., Bergonti, M., Sommariva, E., Guerra, F., Giovagnoni, A., Dello Russo, A., & Casella, M. (2021). Myocardial inflammation, sports practice, and sudden cardiac death: 2021 update. Medicina, 57(3), 277. https://doi.org/10.3390/medicina57030277
Gallinoro, C. M., Scatteia, A., Catapano, D., Pascale, C. E., Russo, G., Di Meglio, F., & Dellegrottaglie, S. (2025). 2020 ESC guidelines on sports cardiology: Impact of CMR criteria on return-to-play clearance after acute myocarditis. Journal of Cardiovascular Development and Disease, 12(12), 469. https://doi.org/10.3390/jcdd12120469
Allwood, R. P., Papadakis, M., & Androulakis, E. (2024). Myocardial fibrosis in young and veteran athletes: Evidence from a systematic review of the current literature. Journal of Clinical Medicine, 13(15), 4536. https://doi.org/10.3390/jcm13154536
Brosnan, M., La Gerche, A., Kalman, J., Lo, W., Fallon, K., MacIsaac, A., & Prior, D. (2014). The seattle criteria increase the specificity of preparticipation ECG screening among elite athletes. British Journal of Sports Medicine, 48(15), 1144–1150. https://doi.org/10.1136/bjsports-2013-092420
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Copyright (c) 2026 Michał Hajt, Weronika Martynowska, Dastin Misiaszek, Anna Wolszczak, Jakub Motor, Alicja Graczyk, Natalia Grabowska, Piotr Ciecierski
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