Cocaine-related aortic dissection: lessons from the International Registry of Acute Aortic Dissection.
BACKGROUND
Acute aortic dissection associated with cocaine use is rare and has been reported predominantly as single cases or in small patient cohorts.


METHODS
Our study analyzed 3584 patients enrolled in the International Registry of Acute Aortic Dissection from 1996 to 2012. We divided the population on the basis of documented cocaine use (C+) versus non cocaine use (C-) and further stratified the cohorts into type A (33 C+/2332, 1.4%) and type B (30 C+/1252, 2.4%) dissection.


RESULTS
C+ patients presented at a younger age and were more likely to be male and black. Type B dissections were more common among C+ patients than in C- patients. Cocaine-related acute aortic dissection was reported more often at US sites than at European sites (86.4%, 51/63 vs 13.6%, 8/63; P < .001). Tobacco use was more prevalent in the C+ cohort. No differences were seen in history of hypertension, known atherosclerosis, or time from symptom onset to presentation. Type B C+ patients were more likely to be hypertensive at presentation. C+ patients had significantly smaller ascending aortic diameters at presentation. Acute renal failure was more common in type A C+ patients; however, mortality was significantly lower in type A C+ patients.


CONCLUSIONS
Cocaine use is implicated in 1.8% of patients with acute aortic dissection. The typical patient is relatively young and has the additional risk factors of hypertension and tobacco use. In-hospital mortality for those with cocaine-related type A dissection is lower than for those with non cocaine-related dissection, likely due to the younger age at presentation.
Cardiovascular Center, University of Michigan, Ann Arbor.
Joshua H
JH
Dean
Cardiovascular Center, University of Michigan, Ann Arbor.
Elise M
EM
Woznicki
Cardiology Department, Brigham & Women's Hospital, Boston, Mass.
Patrick
P
O'Gara
Cardiovascular Center, University of Michigan, Ann Arbor.
Daniel G
DG
Montgomery
Thoracic Aortic Research Center, IRCCS Policlinico San Donato, San Donato, Italy.
Santi
S
Trimarchi
Department of Thoracic and Cardiovascular Surgery, Tromso University Hospital, Tromso, Norway.
Truls
T
Myrmel
Departments of Medicine and Genetics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia.
Reed E
RE
Pyeritz
Cardiovascular Division, Minneapolis Heart Institute, Minneapolis, Minn.
Kevin M
KM
Harris
Cardiovascular Medicine, University of Tokyo, Tokyo, Japan.
Toru
T
Suzuki
Cardiovascular Division, Washington University School of Medicine, St Louis, Mo.
Alan C
AC
Braverman
Division of Thoracic Cardiovascular Surgery, Duke University Medical Center, Durham, NC.
G Chad
GC
Hughes
Cardiovascular Center, University of Michigan, Ann Arbor.
Eva
E
Kline-Rogers
Division of Cardiology and Vascular Medicine, University of Rostock, Rostock, Germany.
Christoph A
CA
Nienaber
Thoracic Aortic Center, Massachusetts General Hospital, Boston.
Eric M
EM
Isselbacher
Cardiovascular Center, University of Michigan, Ann Arbor.
Kim A
KA
Eagle
Cardiology Division, University of Salerno, Salerno, Italy. Electronic address: ebossone@hotmail.com.
Eduardo
E
Bossone
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000139:chemically induced* / Q000175:diagnosis / Q000209:etiology / Q000401:mortality; D001014:Aortic Aneurysm / Q000139:chemically induced* / Q000175:diagnosis / Q000209:etiology / Q000401:mortality; D003042:Cocaine / Q000009:adverse effects*; D019970:Cocaine-Related Disorders / Q000150:complications*; D005260:Female; D006801:Humans; D013287:Illicit Drugs / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012042:Registries; D012307:Risk Factors
D013287:Illicit Drugs; D003042:Cocaine
Acute aortic dissection; Cocaine; Outcomes