Coronary angiographic findings in sport-related acute myocardial infarction: Association between intraluminal thrombus and sport intensity

Introduction Coronary artery disease (CAD) characteristics and severity for sport-related acute myocardial infarction (SR-AMI) remain only poorly investigated, in particular related to sport intensity. Objective To identify coronary angiographic feature of patients with SR-AMI according to sport intensities. Method From the IMACS database, a prospective ongoing monocenter acute MI survey, all consecutive patients hospitalized in a University Hospital from 2010 to 2021 who underwent coronary angiography for SR-MI were included. SR-AMI was defined as MI occurring during sport practice or within the first hour of recovery. Angiographical data were retrospectively analysed by 2 blinded investigators. Sport intensity, expressed in metabolic equivalent (MET), was adapted from Ainsworth classification, with 6 METs as intensity cutoff. Results Among the 173 patients included, median age was 60 y, most were male (90%), and had ST segment elevation MI (STEMI) (Table 1). The SR-AMI often occurred while cycling (41%), jogging (23%), hiking (9%) or playing soccer (9%). Patients commonly underwent Out of Hospital Cardiac Arrest (OHCA) (17%). The rate of cardiovascular (CV) risk factors was high, including current smoking and history of CAD. Most (91%) had significant lesions (>50% stenosis). Revascularisation was achieved by percutaneous coronary intervention (PCI) [n=131 (77%)] or coronary artery bypass grafting (CABG) [n=11(6%)]. In-hospital death occurred in 12 patients (7%), of whom 11 underwent a OHCA and one was admitted with a cardiogenic shock during the COVID-19 pandemics lockdown. When compared with lower intensity sport (<6 METs), patients in the≥6 METs group had similar age, CV risk factors [except for diabetes rate which was much lower (P=0.005)] and similar CAD severity, as assessed by SYNTAX score. Higher intensity group also had a higher rate of STEMI (P=0.05), of intraluminal thrombus (P=0.024), and showed a trend toward a lower rate of calcified lesions (P=0.103). Conclusion Our retrospective study suggests for the first time that SR-AMI occurring during a≥6 METs intensity exercise were characterized by a more frequent thrombotic burden. If confirmed by larger prospective and coronary plaque imaging studies, these preliminary findings could help to understand the underlying mechanisms of these dramatic events.