title: Clinical Profile, Acute Care, and Middle-Term Outcomes of Cocaine-Associated ST-Segment Elevation Myocardial Infarction in an Inner-City Community.
abstract: Although cocaine is a well-recognized risk factor for coronary disease, detailed information is lacking regarding related behavioral and clinical features of cocaine-associated ST-segment elevation myocardial infarction (STEMI), particularly in socioeconomically disadvantaged urban settings. Nor are systematic or extended follow-up data available on outcomes for cocaine-associated STEMI in the contemporary era of percutaneous coronary intervention. We leveraged a prospective STEMI registry from a large health system serving an inner-city community to characterize the clinical features, acute management, and middle-term outcomes of cocaine-related versus cocaine-unrelated STEMI. Of the 1,003 patients included, 60% were black or Hispanic. Compared with cocaine-unrelated STEMI, cocaine-related STEMI (n = 58) was associated with younger age, male gender, lower socioeconomic score, current smoking, high alcohol consumption, and human immunodeficiency virus seropositivity but less commonly with diabetes or hypertension. Cocaine users less often received drug-eluting stents or β blockers at discharge. During median follow-up of 2.7 years, rates of death, death or any rehospitalization, and death or cardiovascular rehospitalization did not differ significantly between cocaine users and nonusers but were especially high for death or any hospitalization in the 2 groups (31.4 vs 32.4 per 100 person-years, p = 0.887). Adjusted hazard ratios for outcomes were likewise not significantly different. In conclusion, in this low-income community, cocaine use occurred in a substantial fraction of STEMI cases, who were younger than their nonuser counterparts but had more prevalent high-risk habits and exhibited similarly high rates of adverse outcomes. These data suggest that programs targeting cocaine abuse and related behaviors could contribute importantly to disease prevention in disadvantaged communities.
authors.affiliation: Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Sanyog G
authors.initials: SG
authors.lastname: Shitole
authors.affiliation: Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Noel
authors.initials: N
authors.lastname: Kayo
authors.affiliation: Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Vankeepuram
authors.initials: V
authors.lastname: Srinivas
authors.affiliation: Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Venkatesh
authors.initials: V
authors.lastname: Alapati
authors.affiliation: Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Charles
authors.initials: C
authors.lastname: Nordin
authors.affiliation: Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York.
authors.forename: William
authors.initials: W
authors.lastname: Southern
authors.affiliation: Department of Medicine, Jacobi Medical Center and Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Panagiota
authors.initials: P
authors.lastname: Christia
authors.affiliation: Department of Medicine, Jacobi Medical Center and Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Robert T
authors.initials: RT
authors.lastname: Faillace
authors.affiliation: Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York.
authors.forename: James
authors.initials: J
authors.lastname: Scheuer
authors.affiliation: Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York. Electronic address: jorge.kizer@einstein.yu.edu.
authors.forename: Jorge R
authors.initials: JR
authors.lastname: Kizer
mesh_terms: D000328:Adult; D000368:Aged; D003042:Cocaine / Q000009:adverse effects*; D019970:Cocaine-Related Disorders / Q000150:complications* / Q000453:epidemiology; D018765:Dopamine Uptake Inhibitors / Q000009:adverse effects; D004562:Electrocardiography / Q000187:drug effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology; D009519:New York City / Q000453:epidemiology; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D013997:Time Factors; D014505:Urban Population
chemical_list: D018765:Dopamine Uptake Inhibitors; D003042:Cocaine