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Characteristics, Management, and Outcomes of Cocaine-Positive Patients With Acute Coronary Syndrome (from the National Cardiovascular Data Registry)

Published:December 13, 2013DOI:https://doi.org/10.1016/j.amjcard.2013.11.023
      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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      References

        • McCord J.
        • Jneid H.
        • Hollander J.E.
        • de Lemos J.A.
        • Cercek B.
        • Hsue P.
        • Gibler W.B.
        • Ohman E.M.
        • Drew B.
        • Philippides G.
        • Newby L.K.
        Management of cocaine-associated chest pain and myocardial infarction: a scientific statement from the American Heart Association Acute Cardiac Care Committee of the Council on Clinical Cardiology.
        Circulation. 2008; 117: 1897-1907
        • Weintraub W.S.
        • McKay C.R.
        • Riner R.N.
        • Ellis S.G.
        • Frommer P.L.
        • Carmichael D.B.
        • Hammermeister K.E.
        • Effros M.N.
        • Bost J.E.
        • Bodycombe D.P.
        The American College of Cardiology National Database: progress and challenges. American College of Cardiology Database Committee.
        J Am Coll Cardiol. 1997; 29: 459-465
        • Brindis R.G.
        • Fitzgerald S.
        • Anderson H.V.
        • Shaw R.E.
        • Weintraub W.S.
        • Williams J.F.
        The American College of Cardiology-National Cardiovascular Data Registry (ACC-NCDR): building a national clinical data repository.
        J Am Coll Cardiol. 2001; 37: 2240-2245
        • Chin C.T.
        • Chen A.Y.
        • Wang T.Y.
        • Alexander K.P.
        • Mathews R.
        • Rumsfeld J.S.
        • Cannon C.P.
        • Fonarow G.C.
        • Peterson E.D.
        • Roe M.T.
        Risk adjustment for in-hospital mortality of contemporary patients with acute myocardial infarction: the Acute Coronary Treatment and Intervention Outcomes Network (ACTION) Registry-Get With The Guidelines (GWTG) acute myocardial infarction mortality model and risk score.
        Am Heart J. 2011; 161 (e112): 113-122
        • Hollander J.E.
        • Hoffman R.S.
        • Gennis P.
        • Fairweather P.
        • DiSano M.J.
        • Schumb D.A.
        • Feldman J.A.
        • Fish S.S.
        • Dyer S.
        • Wax P.
        • Whelan C.
        • Schwarzwald E.
        Prospective multicenter evaluation of cocaine-associated chest pain. Cocaine Associated Chest Pain (COCHPA) Study Group.
        Acad Emerg Med. 1994; 1: 330-339
        • Hollander J.E.
        • Hoffman R.S.
        • Burstein J.L.
        • Shih R.D.
        • Thode Jr., H.C.
        Cocaine-associated myocardial infarction. Mortality and complications. Cocaine-Associated Myocardial Infarction Study Group.
        Arch Intern Med. 1995; 155: 1081-1086
        • Mittleman M.A.
        • Mintzer D.
        • Maclure M.
        • Tofler G.H.
        • Sherwood J.B.
        • Muller J.E.
        Triggering of myocardial infarction by cocaine.
        Circulation. 1999; 99: 2737-2741
        • Lillie-Blanton M.
        • Anthony J.C.
        • Schuster C.R.
        Probing the meaning of racial/ethnic group comparisons in crack cocaine smoking.
        JAMA. 1993; 269: 993-997
        • Stambler B.S.
        • Komamura K.
        • Ihara T.
        • Shannon R.P.
        Acute intravenous cocaine causes transient depression followed by enhanced left ventricular function in conscious dogs.
        Circulation. 1993; 87: 1687-1697
        • Pitts W.R.
        • Vongpatanasin W.
        • Cigarroa J.E.
        • Hillis L.D.
        • Lange R.A.
        Effects of the intracoronary infusion of cocaine on left ventricular systolic and diastolic function in humans.
        Circulation. 1998; 97: 1270-1273
        • Chokshi S.K.
        • Moore R.
        • Pandian N.G.
        • Isner J.M.
        Reversible cardiomyopathy associated with cocaine intoxication.
        Ann Intern Med. 1989; 111: 1039-1040
        • Om A.
        • Warner M.
        • Sabri N.
        • Cecich L.
        • Vetrovec G.
        Frequency of coronary artery disease and left ventricle dysfunction in cocaine users.
        Am J Cardiol. 1992; 69: 1549-1552
        • Nunez B.D.
        • Miao L.
        • Kuntz R.E.
        • Ross J.N.
        • Gladstone S.
        • Baim D.S.
        • Gordon P.C.
        • Morgan J.P.
        • Carrozza Jr., J.P.
        Cardiogenic shock induced by cocaine in swine with normal coronary arteries.
        Cardiovasc Res. 1994; 28: 105-111
        • Carrillo X.
        • Curos A.
        • Muga R.
        • Serra J.
        • Sanvisens A.
        • Bayes-Genis A.
        Acute coronary syndrome and cocaine use: 8-year prevalence and in-hospital outcomes.
        Eur Heart J. 2011;
        • McKee S.A.
        • Applegate R.J.
        • Hoyle J.R.
        • Sacrinty M.T.
        • Kutcher M.A.
        • Sane D.C.
        Cocaine use is associated with an increased risk of stent thrombosis after percutaneous coronary intervention.
        Am Heart J. 2007; 154: 159-164
        • Karlsson G.
        • Rehman J.
        • Kalaria V.
        • Breall J.A.
        Increased incidence of stent thrombosis in patients with cocaine use.
        Catheter Cardiovasc Interv. 2007; 69: 955-958
        • Rangel C.
        • Shu R.G.
        • Lazar L.D.
        • Vittinghoff E.
        • Hsue P.Y.
        • Marcus G.M.
        Beta-blockers for chest pain associated with recent cocaine use.
        Arch Intern Med. 2010; 170: 874-879