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. 2023 Feb;30(2):82-88.
doi: 10.1111/acem.14584. Epub 2022 Sep 8.

Cocaethylene cardiotoxicity in emergency department patients with acute drug overdose

Siri Shastry  1 , Omid Manoochehri  2 , Lynne D Richardson  1   3 , Alex F Manini  1   4
Affiliations

Cocaethylene cardiotoxicity in emergency department patients with acute drug overdose

Siri Shastry et al. Acad Emerg Med. 2023 Feb.

Abstract

Objectives: Cocaine use results in over 500,000 emergency department (ED) visits annually across the United States and ethanol co-ingestion is reported in 34% of these. Commingling cocaine with ethanol results in the metabolite cocaethylene (CE), which is metabolically active for longer than cocaine alone. Current literature on the cardiotoxicity of CE compared to cocaine alone is limited and lacks consensus. This study aims to fill this gap in the literature and examine cardiovascular events in cocaine use as confirmed by urine toxicology versus CE exposure.

Methods: This was a secondary data analysis of a prospective cohort study of adult patients with acute drug overdose at two urban tertiary care hospital EDs over 4 years. Patients with positive urinary cocaine metabolites were analyzed, and outcomes were compared between patients with overdose and confirmed presence of cocaine on urine toxicology (cocaine group) and patients with cocaine and ethanol use (CE group). The primary outcome was cardiac arrest. Secondary outcomes included myocardial injury and hyperlactatemia. Data were analyzed using multivariable regression models.

Results: We enrolled a total of 199 patients (150 cocaine, 49 CE). Rates of cardiac arrest were significantly higher in the CE group compared to cocaine (6.1% vs. 0.67%, p = 0.048). Cocaine was significantly associated with myocardial injury compared to CE exposure (mean initial troponin 0.01 ng/ml vs. 0.16 ng/ml, p = 0.021), while hyperlactatemia was associated with CE exposure (mean initial lactate 4.1 mmol/L vs. 2.9 mmol/L, p = 0.038).

Conclusions: When compared to cocaine exposure alone, CE exposure in ED patients with acute drug overdose was significantly associated with higher occurrence of cardiac arrest, higher mean lactate concentrations, and lower occurrence of myocardial injury.

Keywords: cardiac arrest; cocaethylene; cocaine; overdose.

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Conflict of interest statement

CONFLICT OF INTEREST

The authors declare no potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Summary of study enrollment and patient inclusion/exclusion. Cocaine, UDS positive for cocaine; cocaine-only cohort, UDS positive for cocaine with no co-ingestion of ethanol; Cocaethylene cohort: UDS positive for cocaine with co-ingestion of ethanol. UDS, urine drug screen
See this image and copyright information in PMC

References

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