Letter to the Editor

Increase of sudden cardiac deaths in Switzerland during the 2002 FIFA World Cup

The association between diagnosed acute ST-elevation myocardial infarction (STEMI) and hockey games in the Canadian population is unknown.

We retrospectively analyzed the association between hockey games of the National Hockey League Montreal Canadiens and daily hospital admissions for acute STEMI at the Montreal Heart Institute, Canada.

Between June 2010 and December 2014, a total of 2199 patients (25.9% women; mean age, 62.6 ± 12.4 years) were admitted for acute STEMI. An increase in STEMI admissions was observed the day after a hockey game of the Montreal Canadiens in the overall population (from 1.3 ± 1.2 to 1.5 ± 1.3), however, this difference was not significant (P = 0.1). The number of STEMI admissions increased significantly from 0.9 ± 1.0 to 1.2 ± 1.0 per day in men (P = 0.04), but not in women (P = 0.7). The association between ice hockey matches and STEMI admission rates was strongest after a victory of the Montreal Canadiens. Accordingly, an increased risk for the occurrence of STEMI was observed in the overall population (hazard ratio [HR], 1.15; 95% confidence interval [CI], 1.0-1.3; P = 0.037) when the Montreal Canadiens won a match. This association was present in men (HR, 1.2; 95% CI, 1.03-1.4; P = 0.02) but not in women (P = 0.87), with a most pronounced effect seen in younger men (younger than 55 years; HR, 1.4; 95% CI, 1.1-1.8; P = 0.009).

Although a weak association between hockey games and hospital admissions for STEMI was found in our overall population, the event of a hockey game significantly increased the risk for STEMI in younger men. Preventive measures targeting behavioural changes could positively affect this risk.

On ignore l’association entre le diagnostic d’infarctus du myocarde (IM) aigu avec élévation du segment ST et les matchs de hockey chez la population canadienne.

Nous avons analysé de manière rétrospective l’association entre les matchs de hockey des Canadiens de Montréal de la Ligue nationale de hockey et les admissions quotidiennes en raison d’un IM aigu avec élévation du segment ST à l’Institut de cardiologie de Montréal, au Canada.

Entre juin 2010 et décembre 2014, un total de 2199 patients (25,9 % de femmes ; âge moyen, 62,6 ± 12,4 ans) étaient admis en raison d'un IM aigu avec élévation du segment ST. Nous avons observé une augmentation des admissions en raison d’un IM avec élévation du segment ST après un match de hockey des Canadiens de Montréal dans la population globale (de 1,3 ± 1,2 à 1,5 ± 1,3). Toutefois, cette différence n’était pas significative (P = 0,1). Le nombre d’admissions en raison d’un IM avec élévation du segment ST augmentait de manière significative de 0,9 ± 1,0 à 1,2 ± 1,0 par jour chez les hommes (P = 0,04), mais non chez les femmes (P = 0,7). L’association entre les matchs de hockey sur glace et les taux d’admission en raison d’un IM avec élévation du segment ST était plus forte après une victoire des Canadiens de Montréal. Par conséquent, nous avons observé un risque accru de survenue d’un IM avec élévation du segment ST dans la population globale (rapport de risque [RR], 1,15 ; intervalle de confiance [IC] à 95 %, 1,0-1,3 ; P = 0,037) lorsque les Canadiens de Montréal gagnent le match. Cette association était présente chez les hommes (RR, 1,2 ; IC à 95 %, 1,03-1,4 ; P = 0,02), mais non chez les femmes (P = 0,87), et montrait un effet plus marqué chez les hommes plus jeunes (de moins de 55 ans ; RR, 1,4 ; IC à 95 %, 1,1-1,8 ; P = 0,009).

Bien que nous ayons observé une faible association entre les matchs de hockey et les admissions à l’hôpital en raison d’un IM avec élévation du segment ST dans notre population globale, le fait de regarder un match de hockey augmentait de manière significative le risque d’IM avec élévation du segment ST chez les hommes plus jeunes. Des mesures de prévention qui visent les changements de comportement pourraient influencer de manière positive le risque.

Acute stress may trigger vascular events. We aimed to investigate whether important football competitions involving the French football team increased the occurrence of stroke.

We retrospectively retrieved data of fatal and nonfatal stroke during 4 World Football Cups (1986, 1998, 2002, and 2006) and 4 European Championships (1992, 1996, 2000, and 2004), based on data from the population-based Stroke Registry of Dijon, France. One period of exposure was analyzed: the period of competition extended to 15 days before and after the competitions. The number of strokes was compared between exposed and unexposed corresponding periods of preceding and following years using Poisson regression.

A total of 175 strokes were observed during the exposed periods compared with 192 and 217 strokes in the unexposed preceding and following periods. Multivariate regression analyses showed an overall 30% significant decrease in stroke numbers between periods of competition and unexposed periods of following year (risk ratio (RR) = 1.3; 95% confidence interval [CI] = 1.0-1.6; P = .029) but not with that of preceding year (RR = 1.1; 95% CI = .9-1.3; P = .367). This was mostly explained by a 40% decrease in stroke numbers during European Championships, compared with the unexposed following periods (RR = 1.4; 95% CI = 1.0-1.9; P = .044) in stratified analyses by football competitions.

Watching European football competitions had a positive impact in the city of Dijon with a decrease of stroke numbers. European championship is possibly associated with higher television audience and long-lasting euphoria although other factors may be involved. Further studies using nationwide data are recommended to validate these findings.

It remains controversial, whether spectators of soccer matches are exposed to an increased risk of cardiac events. In 2006, the Soccer World Cup (SWC) took place in Germany and provided an excellent opportunity to assess the effects of emotional stress on cardiac events in a large cohort of soccer enthusiasts in the region of Bavaria.

We analyzed data from the Bavarian Council for Statistics and Data Management for the period of SWC (June 9–July 9, 2006) and reference periods (SWCRef; May 1–July 31, 2005; May 1–June 8, 2006 and July 10–31, 2006) for the following diagnoses: myocardial infarction; myocardial re-infarction; cardiac arrest; paroxysmal tachycardia; atrial fibrillation, atrial flutter; all remaining tachyarrhythmias. Data were compared to the seven days during the tournament, on which the German team played (SWCGerman), the rest of the SWC period (i.e. the days the German team did not play, 24 days, SWCRest) and SWCRef (61 days).

There was neither a significant increase (p > 0.433) in total cardiac events in Bavaria per day during SWCGerman (161.1 ± 46.7) or SWCRest (170.5 ± 52.3) as compared to the SWCRef (176.2 ± 51.8), nor in any investigated diagnosis. After controlling for age, gender, loss of a match, outside temperature and nitric-dioxide air pollution levels the results remained essentially unchanged.

Watching soccer was not associated with an increased incidence of cardiac events, regardless of whether the home team played or not. These data further support the hypothesis that spectators of sporting events are not exposed to an increased risk of cardiac events.