OBJECTIVE: To develop clinical, demographic, and pathological profiles of young 
competitive athletes who died suddenly.
DESIGN: Systematic evaluation of clinical information and circumstances 
associated with sudden deaths; interviews with family members, witnesses, and 
coaches; and analyses of postmortem anatomic, microscopic, and toxicologic data.
PARTICIPANTS AND SETTING: A total of 158 sudden deaths that occurred in trained 
athletes throughout the United States from 1985 through 1995 were analyzed. MAIN 
OUTCOME MEASURES--Characteristics and probable cause of death.
RESULTS: Of 158 sudden deaths among athletes, 24 (15%) were explained by 
noncardiovascular causes. Among the 134 athletes who had cardiovascular causes 
of sudden death, the median age was 17 years (range, 12-40 years), 120 (90%) 
were male, 70 (52%) were white, and 59 (44%) were black. The most common 
competitive sports involved were basketball (47 cases) and football (45 cases), 
together accounting for 68% of sudden deaths. A total of 121 athletes (90%) 
collapsed during or immediately after a training session (78 cases) or a formal 
athletic contest (43 cases), with 80 deaths (63%) occurring between 3 PM and 9 
PM. The most common structural cardiovascular diseases identified at autopsy as 
the primary cause of death were hypertrophic cardiomyopathy (48 athletes [36%]), 
which was disproportionately prevalent in black athletes compared with white 
athletes (48% vs 26% of deaths; P = .01), and malformations involving anomalous 
coronary artery origin (17 athletes [13%]). Of 115 athletes who had a standard 
preparticipation medical evaluation, only 4 (3%) were suspected of having 
cardiovascular disease, and the cardiovascular abnormality responsible for 
sudden death was correctly identified in only 1 athlete (0.9%).
CONCLUSIONS: Sudden death in young competitive athletes usually is precipitated 
by physical activity and may be due to a heterogeneous spectrum of 
cardiovascular disease, most commonly hypertrophic cardiomyopathy. 
Preparticipation screening appeared to be of limited value in identification of 
underlying cardiovascular abnormalities.