Acute Coronary Syndrome in a Master's Athlete and No Modifiable Risk: Gaps in Return-to-Play Guidance

Acute coronary syndrome (ACS) is the leading cause of sudden cardiac death in master's athletes. Current return-to-competition guidelines recommend cardiac rehabilitation and risk factor modification, but do not address athletes lacking modifiable risk factors or revascularization options.

A 46-year-old male competitive runner developed ACS from plaque rupture following a marathon. Stenting was deferred due to malapposition risk with large-caliber coronaries. He completed cardiac rehabilitation and was cleared to return to competition at 6 months. WHY BEYOND THE GUIDELINES?: This patient had no modifiable risk factors and was not a candidate for revascularization, leaving his pre- and postevent cardiovascular risk unchanged despite meeting guideline criteria for return to competition.

Conventional risk stratification tools, including risk calculators and coronary calcium scoring, are less accurate in master's athletes, creating a gap in counseling unrevascularized patients.

Master's athletes with ACS, no modifiable risk factors, and unrevascularized lesions require improved risk stratification tools and further research to guide return-to-competition counseling.