Abstract 1194: Comparison of Cardiovascular Disease Mortality in Young U.S. and Italian Competitive Athletes: Which Preparticipation Screening Strategy is Really More Effective?
Considerable controversy has evolved regarding the most practical and effective strategy for preparticipation screening of competitive athletes to detect unsuspected cardiovascular disease and prevent sudden death on the athletic field. Screening in the Veneto region of Italy (as part of a national program), routinely using the 12-lead ECG has been reported to detect hypertrophic cardiomyopathy de novo and also decrease the overall cardiovascular death rate in young athletes. These observations have been used to suggest that the Italian screening model with ECG is superior to U.S. screening which is limited to history and physical examination. We compared cardiovascular-related death rates in the athletes of Veneto with that in a demographically similar region of the U.S. (i.e., Minnesota) over largely equivalent time periods. In Veneto, 55 sudden cardiovascular deaths were reported in athletes in 26 years (2.1/year) and in Minnesota there were 22 deaths in 23 years (0.96/year). The death rate in Veneto (1.87 deaths/100,000 person-years) exceeded Minnesota (1.06/100,000 p-y; p=0.02) for all years combined, 1979 to 2004. Over the most recent and comparable 11-year period, 1993–2004, there were 12 deaths reported in Veneto and 11 in Minnesota and the 2 regions did not differ significantly (0.87/100,000 p-y vs. 0.93/100,000 p-y, respectively; p=0.87). Also, most recently, 2001 to 2004, death rates in Veneto and Minnesota did not differ (0.43 vs. 0.90/100,000 p-y, respectively; p=0.38). Both regions had similar frequencies of death from cardiomyopathies (16% Veneto vs. 14% Minnesota; p=1.0). Similar proportions of deaths occurred during sports (91% Veneto vs. 87% Minnesota; p=0.68). Despite different preparticipation screening strategies, the rates of cardiovascular disease-related sudden deaths in demographically similar regions of the U.S. (Minnesota) and Italy (Veneto) were nevertheless particularly low, and did not different significantly over the last decade. These data are evidence that the Italian model for screening athletes with ECGs may not substantially reduce cardiovascular death rates beyond that recently achieved in Minnesota with less structured screening methodology.