Implications of Football World and European Championship on STEMI prevalence & care: Myth busting using insights from a metropolitan STEMI network?

Sascha Macherey-Meyer (Köln)1, M. Meertens (Mainz)2, S. Heyne (Köln)3, S. Braumann (Köln)3, I. Ahrens (Köln)4, F. M. Baer (Köln)5, F. Eberhardt (Köln)6, M. Horlitz (Köln)7, J.-M. Sinning (Köln)8, A. Meissner (Köln)9, S. Baldus (Köln)1, C. Adler (Köln)10, S. Lee (Köln)10

1Herzzentrum der Universität zu Köln Klinik für Kardiologie, Angiologie, Pneumologie und Internistische Intensivmedizin Köln, Deutschland; 2Universitätsmedizin der Johannes Gutenberg-Universität Mainz Zentrum für Kardiologie Mainz, Deutschland; 3Herzzentrum der Universität zu Köln Klinik III für Innere Medizin Köln, Deutschland; 4Krankenhaus der Augustinerinnen, Akademisches Lehrkrankenhaus Klinik für Kardiologie und internistische Intensivmedizin Köln, Deutschland; 5St. Antonius Krankenhaus Medizinische Klinik & Kardio-Diabetes-Zentrum Köln Köln, Deutschland; 6Ev. Krankenhaus Köln-Kalk Kardiologie & Internistische Intensivmedizin Köln, Deutschland; 7Krankenhaus Porz am Rhein gGmbH Klinik für Kardiologie, Elektrophysiologie u. Rhythmologie Köln, Deutschland; 8St. Vinzenz-Hospital Innere Medizin III - Kardiologie Köln, Deutschland; 9Kliniken der Stadt Köln gGmbH, Krankenhaus Merheim Medizinische Klinik II Köln, Deutschland; 10Universitätsklinikum Köln Klinik III für Kardiologie, Angiologie, Pneumologie und Internistische Intensivmedizin Köln, Deutschland


Background: Increased prevalence of cardiovascular events was previously related to football events. But systematic reports were inconsistent, differed regionally and cardiac events were heterogeneously defined. Emotional stress, excessive behavior or increased consumption of drinks and tobacco were discussed as contributing factors. ST-segment myocardial infarction (STEMI) is a life-threatening entity of cardiovascular events and subgroup analysis on the impact of football on this population at high mortality risk is warranted.


Objective: This study evaluated the potential association of the Football World and European Championship tournaments and STEMI in a metropolitan STEMI network.


Methods: The infarction registry includes STEMI patients treated between January 2005 and December 2020. Football World and European Championship tournaments (2006-2020) were defined as representative observational periods for continuous exposure to football. These events took place from June to July and followed a rotation principle every two years resulting in 4 World and 4 European Championship tournaments considered for analysis. Patients were divided in football and control group. Data were analyzed using Student’s t-, Chi square, and Fisher’s exact test. 


Results: 4617 patients including 176 (3.8%) in football and 4441 (96.2%) in control group were eligible. Mean age (64.0 vs. 63.3 years, p=0.496) and gender distribution (26.1 vs. 26.2%, p=0.976) did not differ between the groups. The mean daily prevalence of STEMI was 0.75 (football) and 0.79 (control) cases, respectively.

During the pre-interventional course, both groups similarly required resuscitation (17.5 vs. 14.5%, p=0.356), intubation (10.9 vs. 11.9% p=0.689) or vasopressors (10.2 vs. 11.8%, p=0.632). Prolonged cardiogenic shock (13.6 vs. 14.2%, p=0.856) had a comparable prevalence, too. Both groups were equally referred for angiography (99.4 vs. 98.9%, p=1.0). TIMI 0 flow (13.5% each, p=0.998) and stent implantation rate (79.3 vs. 82.2%, p=0.322) were similar between the groups. Incidence of procedure-related complications (6.4 vs. 9.4%, p=0.176), access-site bleeding (1.2 vs. 1.0%, p=0.684), re-infarction (1.8 vs. 1.3%, p=0.483), and stroke (0.8 vs. 1.3%, p=1.000) did not significantly differ. In hospital mortality was 10.9 and 9.4%, respectively (p=0.506).

Timely indicators including symptom-to-contact (368.3 vs. 326.4 min, mean, p=0.443), contact-to-balloon (98.0 vs. 102.3 min, mean, p=0.659) and door-to-balloon (63.9 vs. 63.5 min, mean, p=0.959) interval did not significantly differ.

Conclusion: The present registry analysis did not show an increased prevalence of STEMI during the past football World and European Championship tournaments in a German metropole. There was no evidence for a substantial patient- or system-related treatment delay comparing the groups. Limitations including the presence of other confounders (e.g. season/summer, temperature) and uncertainty regarding the football group’s actual exposure to football should be acknowledged. A prospective observation might be reasonable to validate the present registry results.
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