Heightened risk of cardiac events following percutaneous coronary intervention for cocaine-associated myocardial infarction
Introduction Several works have suggested heightened risk for cardiac events in cocaine users following percutaneous coronary intervention (PCI). Such studies have generally been performed in small, poorly defined samples and have not utilised optimal control groups. We aimed to define the short-ter...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Termedia Publishing House
2019-12-01
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| Series: | Archives of Medical Science |
| Subjects: | |
| Online Access: | https://www.archivesofmedicalscience.com/Heightened-risk-of-cardiac-events-following-percutaneous-coronary-intervention-for,100417,0,2.html |
| _version_ | 1818691889354768384 |
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| author | Ching Wei Russell Chen Mohammed Makkiya Wilbert Aronow Daniel M. Spevack |
| author_facet | Ching Wei Russell Chen Mohammed Makkiya Wilbert Aronow Daniel M. Spevack |
| author_sort | Ching Wei Russell Chen |
| collection | DOAJ |
| description | Introduction
Several works have suggested heightened risk for cardiac events in cocaine users following percutaneous coronary intervention (PCI). Such studies have generally been performed in small, poorly defined samples and have not utilised optimal control groups. We aimed to define the short-term risk for death or recurrent myocardial infarction (MI) when PCI was performed for myocardial infarction in subjects presenting with urine toxicology positive for cocaine in relation to subjects testing negative for cocaine use.
Material and methods
Our institutional electronic health record (EHR) was queried for all subjects with urine toxicology performed for cocaine exposure within 5 days before or after having elevated troponin-T assay between 1/1/08 and 12/31/13. Query results were cross-referenced with our institutional cardiology database to identify the sample who had PCI on the same admission as the cocaine test. Subsequent readmission for MI was assessed from the EHR, and deaths were identified from the National Death Index.
Results
PCI had been performed in 380 subjects who tested negative for cocaine and 44 subjects who tested positive. In the cocaine-positive group, incidences of death or MI at 30 days and 1 year were 18% and 23%, respectively. Those who tested positive for cocaine had increased odds (odds ratio (OR) = 2.3, 95% confidence interval (CI): 1.0–5.1, p = 0.04) for death or MI at 30 days post PCI, after adjustment for age, sex, prior MI, and comorbidity index. Although the odds for events 1-year post PCI were not increased (OR = 2.0, 95% CI: 0.9–4.3), the p-value approached significance in this small sample (p = 0.09).
Conclusions
This retrospective study suggests that PCI performed in cocaine-associated myocardial infarction comes with a high 30-day and one-year risk. Further prospective studies are needed to better define this risk and to lend insight into better management strategies. |
| first_indexed | 2024-12-17T12:49:04Z |
| format | Article |
| id | doaj.art-6e2a4f7170c84ff4b1e7b940541ca492 |
| institution | Directory Open Access Journal |
| issn | 1734-1922 1896-9151 |
| language | English |
| last_indexed | 2024-12-17T12:49:04Z |
| publishDate | 2019-12-01 |
| publisher | Termedia Publishing House |
| record_format | Article |
| series | Archives of Medical Science |
| spelling | doaj.art-6e2a4f7170c84ff4b1e7b940541ca4922022-12-21T21:47:39ZengTermedia Publishing HouseArchives of Medical Science1734-19221896-91512019-12-01161667010.5114/aoms.2020.91287100417Heightened risk of cardiac events following percutaneous coronary intervention for cocaine-associated myocardial infarctionChing Wei Russell Chen0Mohammed Makkiya1Wilbert Aronow2Daniel M. Spevack3Division of Cardiology, Department of Medicine, Montefiore Medical Centre, Albert Einstein College of Medicine, Bronx, New York, USADivision of Cardiology, Department of Medicine, Montefiore Medical Centre, Albert Einstein College of Medicine, Bronx, New York, USADivision of Cardiology, Department of Medicine, Westchester Medical Centre, New York Medical College, Valhalla, New York, USADivision of Cardiology, Department of Medicine, Westchester Medical Centre, New York Medical College, Valhalla, New York, USAIntroduction Several works have suggested heightened risk for cardiac events in cocaine users following percutaneous coronary intervention (PCI). Such studies have generally been performed in small, poorly defined samples and have not utilised optimal control groups. We aimed to define the short-term risk for death or recurrent myocardial infarction (MI) when PCI was performed for myocardial infarction in subjects presenting with urine toxicology positive for cocaine in relation to subjects testing negative for cocaine use. Material and methods Our institutional electronic health record (EHR) was queried for all subjects with urine toxicology performed for cocaine exposure within 5 days before or after having elevated troponin-T assay between 1/1/08 and 12/31/13. Query results were cross-referenced with our institutional cardiology database to identify the sample who had PCI on the same admission as the cocaine test. Subsequent readmission for MI was assessed from the EHR, and deaths were identified from the National Death Index. Results PCI had been performed in 380 subjects who tested negative for cocaine and 44 subjects who tested positive. In the cocaine-positive group, incidences of death or MI at 30 days and 1 year were 18% and 23%, respectively. Those who tested positive for cocaine had increased odds (odds ratio (OR) = 2.3, 95% confidence interval (CI): 1.0–5.1, p = 0.04) for death or MI at 30 days post PCI, after adjustment for age, sex, prior MI, and comorbidity index. Although the odds for events 1-year post PCI were not increased (OR = 2.0, 95% CI: 0.9–4.3), the p-value approached significance in this small sample (p = 0.09). Conclusions This retrospective study suggests that PCI performed in cocaine-associated myocardial infarction comes with a high 30-day and one-year risk. Further prospective studies are needed to better define this risk and to lend insight into better management strategies.https://www.archivesofmedicalscience.com/Heightened-risk-of-cardiac-events-following-percutaneous-coronary-intervention-for,100417,0,2.htmlpercutaneous coronary interventioncocaineacute myocardial infarction |
| spellingShingle | Ching Wei Russell Chen Mohammed Makkiya Wilbert Aronow Daniel M. Spevack Heightened risk of cardiac events following percutaneous coronary intervention for cocaine-associated myocardial infarction Archives of Medical Science percutaneous coronary intervention cocaine acute myocardial infarction |
| title | Heightened risk of cardiac events following percutaneous coronary intervention for cocaine-associated myocardial infarction |
| title_full | Heightened risk of cardiac events following percutaneous coronary intervention for cocaine-associated myocardial infarction |
| title_fullStr | Heightened risk of cardiac events following percutaneous coronary intervention for cocaine-associated myocardial infarction |
| title_full_unstemmed | Heightened risk of cardiac events following percutaneous coronary intervention for cocaine-associated myocardial infarction |
| title_short | Heightened risk of cardiac events following percutaneous coronary intervention for cocaine-associated myocardial infarction |
| title_sort | heightened risk of cardiac events following percutaneous coronary intervention for cocaine associated myocardial infarction |
| topic | percutaneous coronary intervention cocaine acute myocardial infarction |
| url | https://www.archivesofmedicalscience.com/Heightened-risk-of-cardiac-events-following-percutaneous-coronary-intervention-for,100417,0,2.html |
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