In-hospital prognosis of recreational drug use in patients with acute ST-elevation myocardial infarction: insights from the ADDICT-ICCU study

Abstract Background Although recreational drug use may induce ST-elevated myocardial infarction (STEMI), its prevalence in patients hospitalized in intensive cardiac care units (ICCUs), as well as its short-term cardiovascular consequences, remains unknown. Purpose To assess the prevalence of recreational drug use and its prognosis for in-hospital major adverse cardiac events (MACEs) in patients with STEMI. Methods From April 7 to 22, 2021, the Addiction in Intensive Cardiac Care Unit (ADDICT-ICCU) study included prospectively 1575 patients admitted to ICCUs with a systematic urine multidrug test in 39 ICCUs across France. This prespecified study focuses on patients admitted for STEMI. The following recreational drugs were detected within two hours after admission to the ICCU: i) tetrahydrocannabinol including cannabis and marijuana; ii) cocaine; iii) amphetamines; iv) MDMA; and v) heroin and other opioids. Administration of morphine for pain sedation during the initial management of patients was recorded, and their urine test for opioids was considered negative. The primary endpoint was MACEs defined by death, resuscitated cardiac arrest, or cardiogenic shock. Results Among the 325 patients with STEMI (age 62±13 years, 79% men), 41 (12.6%) had a positive test (cannabis: 88%, opioids: 37%, cocaine: 10%, MDMA: 5%). The prevalence of drug use increased to 34% in patients under 50 years of age. Recreational drug users were more frequently men (93% vs. 77%, p=0.02), younger (50±12 years vs. 63±13 years, p<0.001), and more active smokers (78% vs. 34%, p<0.001). Multiple drug use was reported in 16 cases (39%). Of the 41 patients with recreational drug use, 22 (54%) self-reported the use of recreational drugs on admission. During hospitalization, 17 MACEs occurred (5.2%), including 6 deaths (1.8%), 10 cardiogenic shocks (3.1%), and 7 cardiac arrest events (2.2%). Ventricular arrhythmia was more frequent in recreational drug users (9.8% vs. 1.4%, p=0.01). Use of recreational drugs was associated with more MACEs after adjustment for comorbidities (OR=13.6; 95%CI: 3.6-57.3). Conclusion In patients with STEMI, recreational drug use is prevalent, especially in patients under 50 years of age, and is independently associated with an increase of MACEs with more ventricular arrhythmia.Prevalence of recreational drug usePrognosis of recreational drug use