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Frequency of coronary artery disease and left ventricle dysfunction in cocaine users
Insights
Cocaine use is linked to coronary artery disease (CAD) in young adults, with 60% of symptomatic users showing CAD. Myocardial infarction and reduced ejection fraction were common in this patient group.
Area of Science:
- Cardiology
- Toxicology
- Cardiovascular Imaging
Background:
- Cocaine use is associated with cardiovascular complications.
- The spectrum of coronary artery disease (CAD) in cocaine users requires further elucidation.
Purpose of the Study:
- To evaluate the prevalence and severity of coronary artery disease (CAD) in patients with a history of cocaine use and cardiac symptoms.
Main Methods:
- Retrospective review of coronary angiograms from 33 cocaine users presenting with cardiac symptoms.
- Independent review of angiograms by two blinded angiographers.
- Assessment of coronary stenosis, myocardial infarction, and left ventricular ejection fraction.
Main Results:
- 60% of patients (20/33) had significant coronary artery disease (CAD).
- 40% of patients (13/33) had significant CAD (greater than 70% diameter stenosis).
- 36% of patients (12/33) showed evidence of myocardial infarction, all with associated CAD.
Conclusions:
- Cocaine use is associated with a high prevalence of coronary artery disease (CAD), including significant stenosis and myocardial infarction.
- Left ventricular dysfunction is common in cocaine users with CAD.
- Risk factors for CAD were not significantly different between patients with and without CAD.
Abstract:
To evaluate the spectrum of coronary artery disease (CAD) in cocaine users, coronary angiograms obtained from 33 patients (26 men [79%] and 7 women [21%], mean age 37 years) with history of cocaine use and cardiac symptoms were retrospectively reviewed. Clinical indications for coronary angiograms included chest pain (n = 28), congestive failure (n = 4) and complete heart block (n = 1). Coronary angiograms were reviewed independently by 2 angiographers unaware of patient's clinical status. Thirteen patients (40%) had normal coronary angiograms, and 20 (60%) had CAD; 7 (21%) had mild CAD (less than or equal to 70% diameter stenosis), and 13 (40%) had significant CAD (greater than 70% diameter stenosis). Of 13 patients with significant CAD, 7 had 1-vessel, 4 had 2-vessel and 2 had 3-vessel CAD. There was enzymatic evidence of myocardial infarction in 12 of 33 patients (36%); all 12 had CAD (10 with significant and 2 with mild CAD). Mean age and number of risk factors (serum total cholesterol, cigarette smoking, systemic hypertension, diabetes mellitus, family history of CAD, and obesity) in patients with CAD (mild or significant) and with normal coronary angiograms were not statistically different. Left ventricular ejection fraction was normal in 15 patients (45%) and depressed in 18 (55%). All patients with CAD and low ejection fractions (n = 12) had regional wall motion abnormalities, whereas all those with normal coronary arteries and low ejection fraction (n = 6) had global hypokinesia.