Cardiac arrest during vigorous exercise: coronary plaque rupture or myocardial ischaemia?

Only approximately half of the ≥ 50 % luminal stenosis on coronary CTA causes myocardial ischaemia [7]. [...]for the principle that cardiac events are caused by demand ischaemia, coronary CTA is an inadequate screening method. In the study mentioned previously, among 10.9 million marathon runners, the incidence rate was 0.54 per 100,000 participants [1]. [...]to fully establish the additional value of coronary CTA for the prevention of exercise-induced cardiac arrest would require large patient cohorts or even randomised trials. [...]the proposed study by Braber et al. Furthermore, the low predictive value for myocardial ischemia in patients with a ≥ 50 % stenosis on coronary CTA will not lead to the required information, when we assume that exercise-driven cardiac arrest is the result of oxygen-demand mismatch.