Published Online
on May 9, 2005

A more recent version of this article appeared on May 17, 2005

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Submitted on November 10, 2004
Revised on December 16, 2004
Accepted on December 21, 2004

Increased Prevalence of Coronary Artery Aneurysms Among Cocaine Users

Aaron Satran MD, Bradley A. Bart MD, Christopher R. Henry BS, M. Bilal Murad MD, Sumaiya Talukdar BS, Daniel Satran MD, and Timothy D. Henry MD^*

From the Department of Internal Medicine and Division of Cardiology, Hennepin County Medical Center (A.S., B.A.B., M.B.M., S.T., D.S., T.D.H.), University of Minnesota (B.A.B., M.B.M., D.S., T.D.H.), and Minneapolis Heart Institute Foundation (C.R.H., T.D.H.), Minneapolis.

^* To whom correspondence should be addressed. E-mail: henry003{at}umn.edu.

Background--Cocaine abuse has been implicated in multiple cardiovascular complications. Coronary artery aneurysms (CAAs) and ectasia occur in 0.2% to 5.3% of patients referred for angiography and are associated with atherosclerosis, Kawasaki’s disease, and several rare disorders. After observing CAAs in multiple young cocaine users, we investigated the prevalence of CAAs among cocaine users undergoing coronary angiography.

Methods and Results--Clinical and angiographic characteristics of 112 consecutive patients with a history of cocaine use and coronary angiography were compared with a control group of similar age and risk factors from an existing angiographic database over the same time period. Coronary angiograms were independently read by 3 reviewers blinded to cocaine use. Cocaine users were young (mean age, 44 years), predominantly male (80%), and cigarette smokers (95%). Control patients had higher rates of diabetes (33%) and more severe coronary artery disease (P=0.01). Previous myocardial infarction was common in both groups (45% of cocaine users, 38% of control patients). Despite the frequent history of myocardial infarction among cocaine users, 48% had nonobstructive coronary artery disease. Among cocaine users, 34 of 112 (30.4%) had CAAs compared with 6 of 79 (7.6%) in the control group (P<0.001). Cocaine use was a strong predictor of CAA by univariate and multivariate analyses.

Conclusions--This is the first description of an association between cocaine use and CAA. The prevalence of CAA among cocaine users was higher than expected (30.4%), given such a young cohort. Cocaine use may predispose to the formation of CAA, which may in turn be a contributing factor to myocardial infarction.

Key words: cocaine • coronary aneurysm • dilatation, pathologic • myocardial infarction

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