Acute Coronary Syndrome and Cocaine Use
Acute Coronary Syndrome and Cocaine Use
Aims The use of cocaine as a recreational drug has increased in recent years. The aims of this study were to analyse the prevalence and inhospital evolution of acute coronary syndrome (ACS) associated with cocaine consumption (ACS-ACC).
Methods and results Prospective analysis of ACS patients admitted to a coronary care unit from January 2001 to December 2008. During the study period, 2752 patients were admitted for ACS, and among these 479 were ≤50 years of age. 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 aged 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). Acute coronary syndrome associated with cocaine consumption 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 the left ventricular ejection fraction (44.5 vs. 52.2%, P = 0.049), and increased inhospital mortality (8.3 vs. 0.8%, P = 0.030).
Conclusions The association between cocaine use and ACS has increased significantly over the past few years. Young adults with ACS-ACC that require admission to the coronary care unit have greater myocardial damage and more frequent complications.
The use of cocaine as a recreational drug is growing around the world, with 13 million Europeans estimated to have used cocaine at some point in their lives, representing 3.9% of adults between the ages of 15 and 64. The highest prevalence of cocaine use in Europe is found in Spain (8.3%), with an annual incidence of 3.1%. A parallel increase in medical complications associated with cocaine use has been observed. The number of treatments initiated for addiction in 2007 was 61 000 in Europe, and the number of emergency room visits caused by cocaine use represented between 12 and 41 cases for every 100 000 emergencies, of which between 6.7 and 25% were for cardiovascular complications. Cocaine causes more cardiovascular complications than any other illegal drug.
Both acute and chronic cocaine use may cause arterial hypertension, aortic dissection, arrhythmias, acute pulmonary oedema, cardiomyopathy, and sudden death. The association between acute coronary syndrome (ACS) and cocaine consumption was first described by Coleman et al. in the early 1980s and later by Mittleman et al. in a large series. Cocaine use causes coronary vasospasm through a direct effect on the α-adrenergic receptors and increases thrombogenicity through procoagulant factors released by platelets and endothelial cells, with the development of intracoronary thrombosis. Increased coronary artery disease (CAD) burden has been reported in chronic cocaine users both by autopsy and angiography.
This study aimed to evaluate the prevalence and inhospital evolution of ACS associated with cocaine consumption (ACS-ACC) in young adults at a university hospital in Barcelona metro area between 2001 and 2008.
Abstract and Introduction
Abstract
Aims The use of cocaine as a recreational drug has increased in recent years. The aims of this study were to analyse the prevalence and inhospital evolution of acute coronary syndrome (ACS) associated with cocaine consumption (ACS-ACC).
Methods and results Prospective analysis of ACS patients admitted to a coronary care unit from January 2001 to December 2008. During the study period, 2752 patients were admitted for ACS, and among these 479 were ≤50 years of age. 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 aged 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). Acute coronary syndrome associated with cocaine consumption 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 the left ventricular ejection fraction (44.5 vs. 52.2%, P = 0.049), and increased inhospital mortality (8.3 vs. 0.8%, P = 0.030).
Conclusions The association between cocaine use and ACS has increased significantly over the past few years. Young adults with ACS-ACC that require admission to the coronary care unit have greater myocardial damage and more frequent complications.
Introduction
The use of cocaine as a recreational drug is growing around the world, with 13 million Europeans estimated to have used cocaine at some point in their lives, representing 3.9% of adults between the ages of 15 and 64. The highest prevalence of cocaine use in Europe is found in Spain (8.3%), with an annual incidence of 3.1%. A parallel increase in medical complications associated with cocaine use has been observed. The number of treatments initiated for addiction in 2007 was 61 000 in Europe, and the number of emergency room visits caused by cocaine use represented between 12 and 41 cases for every 100 000 emergencies, of which between 6.7 and 25% were for cardiovascular complications. Cocaine causes more cardiovascular complications than any other illegal drug.
Both acute and chronic cocaine use may cause arterial hypertension, aortic dissection, arrhythmias, acute pulmonary oedema, cardiomyopathy, and sudden death. The association between acute coronary syndrome (ACS) and cocaine consumption was first described by Coleman et al. in the early 1980s and later by Mittleman et al. in a large series. Cocaine use causes coronary vasospasm through a direct effect on the α-adrenergic receptors and increases thrombogenicity through procoagulant factors released by platelets and endothelial cells, with the development of intracoronary thrombosis. Increased coronary artery disease (CAD) burden has been reported in chronic cocaine users both by autopsy and angiography.
This study aimed to evaluate the prevalence and inhospital evolution of ACS associated with cocaine consumption (ACS-ACC) in young adults at a university hospital in Barcelona metro area between 2001 and 2008.