Super Bowl Sunday is approaching: open the cath lab

February 1, 2008 By Benjamin A. Olenchock, M.D. Ph.D. [mailto:bolenchock@partners.org]

Munich The correlation between Boston sporting events and business in the Brigham cardiac care unit is a popular subject on call nights. The association was explained to me by Ben Scirica, who predicted a slow night as the Red Socks played in the World Series, followed by a rush of myocardial infarctions after their victory. As it turns out, he was right. And now, new research published in The New England Journal of Medicine provides data to support personal experience.

Researchers in Munich analyzed 4279 cardiovascular events that occurred from June through July of 2006, when Germany was hosting the FIFA World Cup. They compared event rates over the surrounding months with rates during control periods in 2003 and 2005. Data were collected from 15 emergency services areas, including Munich area hospitals and intensive care vehicles. They chose to omit data from 2004 to avoid any possible influence from the European Championship tournament in Portugal that year. Only local residents were included to exclude the possibility that changing population on game days might influence the results. Event rates were compared among three different periods: the 7 days during which Germany played, the 24 days of the World Cup when Germany did not play, and 242 control days.

With the exception of the Germany vs. Portugal match for third place (boring!), event rates during Germany match days and during the final World Cup match between Italy and France are much higher. The incidence on Germany match days was 2.66 times higher than on control days (CI 2.33 to 3.04, p<0.001). There was no increased rate of events when foreign teams were playing. Interestingly, the proportion of events that were in patients with known coronary heart disease was much higher on those days (47% vs. 29% on a control day). The event rates for STEMI, NSTEMI and cardiac arrhythmia were all statistically increased. The highest incidence was seen during the first 2 hours of watching the match. Men were most at risk (72% of events on match day compared with 57% on a control day). Women, though, were also more likely to have a cardiovascular event on match day (incidence ratio 1.82, OR 1.44 to 2.31, p<0.001). The sex difference might be influenced by differences in interest in the outcome of the match or differences in pathophysiology.

The one part that is inconsistent with Brigham folklore is the time to presentation. Perhaps Bostonians are better able to tolerate chest pain and wait until after the game is over to present with acute coronary syndromes. Or perhaps baseball is not quite as exhilarating as soccer. As the Superbowl approaches, these data should be taken seriously. A greater than 2-fold higher event rate is quite significant. As the authors point out, we need to recognize the high risk associated with stressful events and develop prevention strategies.