Abstract 19704: Prevalence of Traditional Risk Factors and Clinical Outcome of ST Segment Elevation Myocardial Infarction Associated with Cocaine Use
Cocaine abuse has been implicated in acute myocardial infarction by a number of pathophysiological mechanisms but the prevalence of traditional risk factors and its impact on overall mortality has not been systematically studied in this population. The purpose of this study is to evaluate the prevalence of risk factors and the clinical outcome of a population of patients who presented with ST-segment elevation infarction (STEMI) in the setting of cocaine use.
This is a retrospective analysis of 655 STEMI patients who were candidates for primary PCI between 2006 and 2012. A total of 47 patients were identified who had a positive toxicology screening for cocaine and cardiac enzymes for the index admission. Demographics, risk factor prevalence and clinical outcome of cocaine abusers were compared to the overall STEMI population.
A total of 47 patients from a cohort of 655 (7.1%) were cocaine users (CU). CU were younger, mean age in non cocaine users (NCU) was 60.5, and in CU 48.5 (P<0.01). NCU had a higher prevalence of traditional risk factors for coronary artery disease (CAD) including diabetes 33.0% vs 19.1 % (P=0.03), chronic kidney disease 8% vs 2.5 % (P=0.02), smoking 86.9% vs 49.1% (P<0.01), hyperlipidemia 62 % vs 51 % (P=0.08) and previously diagnosed CAD 28.4 % vs 17 % (P= 0.06). Hypertension was the only traditional risk factor that was equally prevalent 67,2% vs 70.2% (P=0.67). The time to treatment was not different between the groups with a mean door-to-balloon time of 74.4 minutes for NCU and 67.8 minutes for CU (P= 0.54). The percentage of patients with non-obstructive CAD was higher in CU compared to NCU 45.4% vs 10.9% (P<0.01); Analyzing the number of arteries involved, we found that multivessel disease was more common in NCU compared to CU 95.6% vs 4.4% (P=0.002). Despite equal treatment times, less severe CAD and risk factors, mortality was higher in CU 14.8% versus NCU 6.08% (P =0.03)
Cocaine users presenting with STEMI have a higher cardiovascular mortality compared to non-cocaine users despite a lower prevalence of the traditional risk factors for CAD and less extensive CAD.
Author Disclosures: C. Gomez: None. C. Rueda: None. M. Calfa: None. E. de Marchena: None. C. Alfonso: None. C. Mendoza: None. J.P. Zambrano: None. R. Vazquez-Padron: None. J.C. Duque: None. N. Fernandez: None. Y. Alansari: None. S. Perez: None. A. Ferreira: None.
- © 2014 by American Heart Association, Inc.