Cocaine use is associated with an increased risk of stent thrombosis after percutaneous coronary intervention.
BACKGROUND
The treatment of cocaine-related acute coronary syndromes presents unique challenges. Although percutaneous coronary intervention in cocaine abusers appears to be safe in the short term, longer-term outcomes have not been reported. We postulated that cocaine use would be associated with increased risk for stent thrombosis.


METHODS
We report 30-day and 9-month clinical outcomes including stent thrombosis, myocardial infarction, repeat revascularization, and death in 71 cocaine abusers who underwent percutaneous coronary intervention at our institution (66 of whom received a stent) compared with 3216 control patients. Propensity score-matched analysis was performed to control for statistical bias present in nonrandomized study populations.


RESULTS
Stent thrombosis occurred in 5 (7.6%) of the 66 stented cocaine abusers during the 9-month follow-up period compared to a 0.6% rate of stent thrombosis in the control database, a highly statistically significant difference (P < .001). In the propensity analysis, stent thrombosis occurred in 4 stented cocaine abusers and 0 of 70 matched controls (6.2% vs 0%; P = .04) throughout the 9-month follow-up period. There was no significant difference in overall rates of myocardial infarction, death, or repeat revascularization at 9 months.


CONCLUSIONS
Because of the increased risk of stent thrombosis, consideration should be given to a more conservative approach in cocaine abusers who present with acute coronary syndromes.
McKee
Scott A
SA
Wake Forest University School of Medicine, Winston Salem, NC, USA.
Applegate
Robert J
RJ
Hoyle
John R
JR
Sacrinty
Matthew T
MT
Kutcher
Michael A
MA
Sane
David C
DC
D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000401:mortality* / Q000706:statistics & numerical data; D015984:Causality; D003042:Cocaine / Q000009:adverse effects*; D019970:Cocaine-Related Disorders / Q000453:epidemiology*; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects / Q000706:statistics & numerical data*; D015996:Survival Rate; D013927:Thrombosis / Q000453:epidemiology* / Q000209:etiology
D003042:Cocaine