Although cocaine ingestion may cause or contribute to myocardial infarction (MI),
few contemporary data are available describing cocaine-associated MI. We describe
the characteristics, management, and outcomes of patients with MI and recent cocaine
use from the Acute Coronary Treatment and Intervention Outcomes Network Registry—Get
With The Guidelines (ACTION Registry-GWTG) program. The study population was 102,952
patients enrolled in the American College of Cardiology ACTION Registry-GWTG from
July 2008 to March 31, 2010 from 460 sites across the United States. Cocaine exposure
was defined as self-reported cocaine use within the last 72 hours or a positive urine
test for cocaine. Demographics and medical history, presenting characteristics, treatments,
and in-hospital outcomes were reported on a standard case record form. A total of
924 patients (0.9%) were cocaine positive. Compared with cocaine-negative patients,
cocaine-positive patients were younger and predominantly men with fewer cardiovascular
risk factors. There was a higher percentage of ST elevation myocardial infarction
(STEMI) (46.3% vs 39.7%) and cardiogenic shock at presentation in the cocaine-positive
group, but the percentage of multivessel coronary artery disease was lower (53.3%
vs 64.5%). Beta blockers within 24 hours (85.8% vs 90.1%, p <0.0001) and drug-eluting
stents (40.1% vs 68.8%, p <0.0001 in patients with non-STEMI; 27.6% vs 54.6%, p <0.0001
in patients with STEMI) were used less commonly in cocaine-positive patients. Multivariable-adjusted
in-hospital mortality was similar between cocaine-positive and cocaine-negative patients
(adjusted odds ratio 1.00, 95% confidence interval 0.69 to 1.44, p value = 0.98).
In conclusion cocaine-positive patients with acute coronary syndrome are younger with
fewer risk factors, multivessel coronary artery disease and lower drug-eluting stent
and β-blocker usage. Cocaine use was not associated with in-hospital mortality.
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Article Info
Publication History
Published online: December 13, 2013
Accepted:
November 7,
2013
Received in revised form:
November 7,
2013
Received:
July 15,
2013
Footnotes
This research was supported by the American College of Cardiology Foundation's National Cardiovascular Data Registry (NCDR, Washington, DC) . The views expressed in this manuscript represent those of the author(s), and do not necessarily represent the official views of the NCDR or its associated professional societies identified at www.ncdr.com.
ACTION Registry-GWTG is an initiative of the American College of Cardiology Foundation and the American Heart Association, with partnering support from the Society of Chest Pain Centers, the American College of Emergency Physicians, and the Society of Hospital Medicine.
See page 755 for disclosure information.
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© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
