61,146 finishers in record NYC Marathon where 24-year-old runner died
Rachel Apa of Pennsylvania collapsed two miles before the line on Sunday and died from rhabdomyolysis, a rare condition where muscle tissue breaks down.
By Jonathan Ramirez ·
New York City Police confirmed on Tuesday that Rachel Apa, a 24-year-old woman from Lewisberry, Pennsylvania, died after collapsing during the New York City Marathon on Sunday. The incident occurred just two miles before the finish line. The city medical examiner's office is currently investigating the death.
Apa's father, Steve Apa, told the New York Times that doctors identified the cause as rhabdomyolysis. The condition, often called rhabdo, involves the rapid breakdown of skeletal muscle. This process releases substances into the blood that can poison the body, damage kidneys, or trigger heart failure and organ shutdown.
The race itself set a record for participation. A total of 61,146 runners crossed the finish line, marking the largest marathon in history. Despite the high number of participants, experts note that deaths during marathons remain extremely rare.
Dr. Jonathan Kim, founding director of Emory Sports Cardiology, stated that a young woman dying while running a marathon is not a common occurrence. Kim co-authored studies analyzing 23 years of death data from US marathons. He noted that the most common cause of sudden cardiac arrest in these events is a heart attack. For younger runners, a significant portion of cardiac arrest deaths are classified as unexplained even after thorough medical review.
Dr. Doug Farrell, a nephrologist at Mount Sinai, pointed to environmental factors that can worsen muscle breakdown. Farrell published a study in April documenting a spike in rhabdo cases during the 2022 New York City Marathon. That year, medical staff treated 24 runners for the condition, compared to the usual three or four. Farrell attributed the increase to heat and humidity. The 2022 heat index exceeded 76 degrees, making it the hottest November race since the event moved to that month in 1986. Runners often struggle to acclimate when race day is much hotter than the preceding two weeks.
Temperatures on Sunday were milder, hovering in the mid-60s. Farrell explained that heat makes sweating less effective at cooling the body. When core body temperatures exceed 104 degrees, muscle tissue breaks down faster. Dehydration can further complicate the issue. Early symptoms of rhabdo, such as exhaustion, nausea, and muscle aches, can blend in with the normal discomfort of a long race. Farrell said many of his patients sought care only after passing out or becoming delirious.
When Apa collapsed, a bystander began CPR and race staff used a defibrillator. Paramedics transported her to a hospital where she died. Kim noted that while severe rhabdo cases can strike athletes who train in heat or without sufficient preparation, most are treated with intravenous fluids and recover. He added that the survival rate for people who go into cardiac arrest while running is close to 70 percent. This rate is significantly higher than the 10 percent survival rate for standard out-of-hospital cardiac arrests.
Apa was a former Division I field hockey player for Bucknell University, where she graduated in 2024. This was her first marathon. She entered the race to raise money for Parkinson's disease in honor of her grandfather, who died from the condition in 2022. Her fundraising page stated that he taught her to push her limits and embrace challenges. Her specific training regimen and family medical history have not been released.
Kim advised runners to consult doctors before signing up for marathons, particularly if they have risk factors like high cholesterol or a family history of heart disease. He urged athletes to watch for signs of heart trouble, including chest tightness and lightheadedness. Kim said that nearly 30 million people ran in races from 2010 to 2023, yet the chance of dying from sudden cardiac arrest fell by half over that period.
