Increased prevalence of coronary artery aneurysms among cocaine users.
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.


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.
Satran
Aaron
A
Department of Internal Medicine and Division of Cardiology, Hennepin County Medical Center, Minneapolis, USA.
Bart
Bradley A
BA
Henry
Christopher R
CR
Murad
M Bilal
MB
Talukdar
Sumaiya
S
Satran
Daniel
D
Henry
Timothy D
TD
D000328:Adult; D000704:Analysis of Variance; D016022:Case-Control Studies; D003042:Cocaine / Q000009:adverse effects; D019970:Cocaine-Related Disorders / Q000150:complications*; D003323:Coronary Aneurysm / Q000139:chemically induced* / Q000453:epidemiology*; D017023:Coronary Angiography; D003324:Coronary Artery Disease; D004108:Dilatation, Pathologic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction; D015995:Prevalence
D003042:Cocaine