Abstract 3057: Cocaine use is Associated with an Increased Risk of Stent Thrombosis After Percutaneous Coronary Intervention
Introduction: Cocaine use is an increasingly common cause of acute coronary syndromes in the US. Most of these patients are treated according to standard guidelines, including PCI with stenting when indicated. We studied the hypothesis that cocaine use increases adverse events associated with PCI, specifically the risk of stent thrombosis.
Methods and Results: We performed a retrospective chart review of 71 patients who underwent PCI with stenting at our institution from 1998 to 2005 and had a documented history of cocaine abuse. We then identified propensity-matched controls with no history of cocaine use from a database of PCI patients. Matched controls were successfully identified for 70 of the cocaine abusers. Rates of death, MI, repeat revascularization, and stent thrombosis were compared at 30 days and 9 months. Results are summarized in the Table⇓. Cocaine abusers had an increased risk of stent thrombosis (7% vs. 0%, p = 0.050) and MI or death (15.8% vs. 4.8%, p=0.048) compared to the propensity-matched controls at 9 months. Overall MACE (death, MI, and repeat revascularization) rates, however, were not different (22.6% vs. 17.7%, p=0.492).
Conclusions: These data suggest that there is an increased risk of stent thrombosis in patients with a history of cocaine abuse. Potential explanations for this finding include cocaine-mediated platelet activation and vasoconstriction as well as medical non-compliance. Because of the increased risk of stent thrombosis, cocaine abusers who present with acute coronary syndrome may benefit from intensive initial medical therapy followed by a selective invasive strategy in non-responders.