Cocaine or marijuana use was associated with worse all-cause and cardiovascular mortality among patients younger than 50 years who experienced a myocardial infarction (MI). This was the finding from the Partners YOUNG-MI study presented by Ersilia M. DeFilippis, MD, at ACC.18 and simultaneously published in the Journal of the American College of Cardiology.

The retrospective registry study assessed the prevalence of cocaine and marijuana use and its association with outcomes in young adults presenting with their first MI at ≤50 years of age. Patients who used both drugs were included in the cocaine group for the analysis. The primary endpoints were cardiovascular and all-cause mortality. Secondary endpoints included cardiac arrest at presentation and coronary revascularization.

The study included 2,097 patients with Type I MI. Cocaine or marijuana use was present in 10.7 percent of patients, with 4.7 percent using marijuana and 6.0 percent using cocaine. Both substances were used by 36 patients. Patients with substance use were younger and male. A significantly higher percentage of STEMIs occurred in the substance use group vs. the non-substance use group (64.7 vs. 52.1 percent). Patients with substance use had significantly lower rates of diabetes and hyperlipidemia but significantly higher rates of tobacco use.

Out-of-hospital cardiac arrest occurred significantly more often in patients with substance use vs. those without (8.0 vs. 3.5 percent). This difference was largely driven by increased cardiac arrest in the marijuana group. There were no significant differences in the rates of coronary revascularization.

During a median follow-up of 11.2 years, patients with substance use had significantly higher all-cause mortality vs. those without (18.8 vs. 11.3 percent). The adjusted hazard ratios for all-cause death were 1.99 for any substance use, 2.09 for marijuana and 1.91 for cocaine. Cardiovascular mortality was significantly higher among patients with substance use vs. those without (9.4 vs. 5.3 percent). The adjusted hazard ratios for cardiovascular death were 2.22 for any substance use, 2.13 for marijuana use and 2.32 for cocaine use.

“These findings reinforce current recommendations for screening for substance abuse among adults who experience an MI at a young age, and highlight the need for implementation of therapies and counseling that could prevent future adverse events,” write the authors.

Keywords: ACC18, ACC Annual Scientific Session, Cannabis, Marijuana Smoking, Marijuana Abuse, Cocaine, Out-of-Hospital Cardiac Arrest, Retrospective Studies, Follow-Up Studies, Myocardial Infarction, Cocaine-Related Disorders, Registries, Tobacco Use, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Hyperlipidemias, Counseling

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