Trends in prevalence and outcomes of acute coronary syndrome associated with cocaine consumption: The RUTI-cocaine study

Abstract

Background: The use of cocaine as a recreational drug has increased over recent years. In this study, we aimed to analyze the prevalence, and in-hospital and long-term outcomes of acute coronary syndrome (ACS) associated with cocaine consumption (ACS-ACC).

Methods: A prospective observational registry of young patients hospitalised with ACS from 2001 through 2015, we analysed ACS-ACC temporal trends, clinical characteristics, and major adverse cardiovascular events (MACE) during long-term follow-up.

Results: There were 8153 admissions with ACS, of whom 864 patients were ≤50-years-old; 59 patients (6.8%) presented with ACS-ACC. The prevalence of patients with a history of cocaine consumption increased to maximum of 18% in 2008 with no variations thereafter (r = 0.74, p < 0.001). The ACS-ACC incidence increased over time from 5% to 9% (r = 0.25, p = 0.07). Compared to patients with ACS not associated with cocaine consumption, the ACS-ACC exhibited a higher incidence of in-hospital ventricular tachycardia (16.9% vs 4.7%, p < 0.001) and trends to in-hospital mortality (3.4% vs 1.0%, p = 0.097); during a median follow-up of 5.6 years, ACS-ACC had higher risk of MACE (HR 1.83; 95% CI 1.04-3.25, p = 0.038), higher risk of myocardial infarction (HR 2.39, 95% CI 1.02-5.60, p = 0.045), and higher risk of cardiovascular mortality (HR 6.26; 95% CI 1.67-23.43, p = 0.006).

Conclusion: Young patients with ACS-ACC carry a high risk of short and long-term major adverse cardiovascular events. Over the 15-year study period, we observed an increasing prevalence of this entity. This trend and its outcomes underscore the need for increased awareness and improved management strategies.

Keywords: Acute coronary syndrome; Cocaine addiction; Cocaine consumption; Myocardial infarction; Pharmacological treatment.