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To develop a precompetition medical assessment (PCMA) of elite football players aimed at identifying risk factors for sudden cardiac death.Retrospective analysis of the PCMA forms.Of the 32 national teams (with 23 players), PCMA forms from 605 players were submitted after the final match (82%). Data of 582 players were analyzed (79%).Recorded results of a standardized PCMA in all players before the 2006 FIFA World Cup including medical history, physical examination, resting/exercise electrocardiogram, and echocardiography were analyzed by 2 independent cardiologic reviewers.Apart from general deficits in data quality, at least 6 players (1.0%) could be identified as demanding further investigations to rule out a serious cardiovascular disease.Comprehensive cardiac testing is feasible in international elite football. To improve future results, the PCMA was revised. It is questionable if exercise stress testing should be included in future PCMA. To ensure correct results, sports cardiologic expertise is essential. In the face of organizational challenges and variable medical standards, alternative approaches to the practical implementation of the PCMA need to be investigated.