Acute Coronary Syndrome and Cocaine Use: 8-Year Prevalence and Inhospital Outcomes

Study Questions:

What is the prevalence and in-hospital evolution of acute coronary syndrome (ACS) associated with cocaine consumption (ACS-ACC)?

Methods:

This was a prospective analysis of ACS patients admitted to a coronary care unit from January 2001 to December 2008. During the study period, 2,752 patients were admitted for ACS, and among these, 479 were ≤50 years of age. Differences between ACS-ACC and ACS-NACC were examined with Student’s t-test for continuous variables and χ2 test for dichotomous variables, using Fisher’s exact test when needed.

Results:

Fifty-six (11.7%) patients had a medical history of cocaine use with an increase in prevalence from 6.8% in 2001 to 21.7% in 2008 (p = 0.035). Among patients younger than 30 years of age, 25% admitted to being users compared with 5.5% of those ages 45-50 years (p = 0.007). Similarly, the prevalence of positive urine tests for cocaine was four times higher in the younger patients (18.2 vs. 4.1%, p = 0.035). ACS-ACC patients (n = 24; those who had a positive urine test for cocaine or who admitted to being users upon admission) had larger myocardial infarcts as indicated by troponin I levels (52.9 vs. 23.4 ng/ml, p < 0.001), lower left ventricular ejection fraction (44.5 vs. 52.2%, p = 0.049), and increased in-hospital mortality (8.3 vs. 0.8%, p = 0.030).

Conclusions:

The authors concluded that the association between cocaine use and ACS has increased significantly over the past few years.

Perspective:

The primary findings of this study are the identification of a steady increase in cocaine consumption among young patients with ACS and the adverse prognosis of these patients compared with patients with ACS-NACC. Based on this study, it seems prudent to incorporate a specific medical history on cocaine use and urine tests for cocaine at the time of admission into patient care protocols for young adults with suspected ACS.

Clinical Topics: Acute Coronary Syndromes

Keywords: Prevalence, Myocardial Infarction, Acute Coronary Syndrome, Cocaine, Hospital Mortality, Cocaine-Related Disorders


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