title: Characteristics, management, and outcomes of cocaine-positive patients with acute coronary syndrome (from the National Cardiovascular Data Registry).
abstract: Although cocaine ingestion may cause or contribute to myocardial infarction (MI), few contemporary data are available describing cocaine-associated MI. We describe the characteristics, management, and outcomes of patients with MI and recent cocaine use from the Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With The Guidelines (ACTION Registry-GWTG) program. The study population was 102,952 patients enrolled in the American College of Cardiology ACTION Registry-GWTG from July 2008 to March 31, 2010 from 460 sites across the United States. Cocaine exposure was defined as self-reported cocaine use within the last 72 hours or a positive urine test for cocaine. Demographics and medical history, presenting characteristics, treatments, and in-hospital outcomes were reported on a standard case record form. A total of 924 patients (0.9%) were cocaine positive. Compared with cocaine-negative patients, cocaine-positive patients were younger and predominantly men with fewer cardiovascular risk factors. There was a higher percentage of ST elevation myocardial infarction (STEMI) (46.3% vs 39.7%) and cardiogenic shock at presentation in the cocaine-positive group, but the percentage of multivessel coronary artery disease was lower (53.3% vs 64.5%). Beta blockers within 24 hours (85.8% vs 90.1%, p <0.0001) and drug-eluting stents (40.1% vs 68.8%, p <0.0001 in patients with non-STEMI; 27.6% vs 54.6%, p <0.0001 in patients with STEMI) were used less commonly in cocaine-positive patients. Multivariable-adjusted in-hospital mortality was similar between cocaine-positive and cocaine-negative patients (adjusted odds ratio 1.00, 95% confidence interval 0.69 to 1.44, p value = 0.98). In conclusion cocaine-positive patients with acute coronary syndrome are younger with fewer risk factors, multivessel coronary artery disease and lower drug-eluting stent and β-blocker usage. Cocaine use was not associated with in-hospital mortality.
authors.affiliation: Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin. Electronic address: dr_navdeep@yahoo.com.
authors.forename: Navdeep
authors.initials: N
authors.lastname: Gupta
authors.affiliation: Duke Heart Center, Duke University Medical Center, Durham, North Carolina.
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Washam
authors.affiliation: Department of Medicine, Section of Cardiac Electrophysiology, North Shore University Hospital, Manhasset, New York.
authors.forename: Stavros E
authors.initials: SE
authors.lastname: Mountantonakis
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
authors.forename: Shuang
authors.initials: S
authors.lastname: Li
authors.affiliation: Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Roe
authors.affiliation: Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: James A
authors.initials: JA
authors.lastname: de Lemos
authors.affiliation: Department of Medicine, Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois.
authors.forename: Rohit
authors.initials: R
authors.lastname: Arora
mesh_terms: D054058:Acute Coronary Syndrome / Q000139:chemically induced* / Q000628:therapy; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D003042:Cocaine / Q000009:adverse effects; D019970:Cocaine-Related Disorders / Q000150:complications*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000139:chemically induced* / Q000453:epidemiology / Q000628:therapy; D062645:Percutaneous Coronary Intervention / Q000706:statistics & numerical data; D012042:Registries; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000453:epidemiology; D015607:Stents / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology
chemical_list: D000319:Adrenergic beta-Antagonists; D003042:Cocaine