Author + information
- Received October 9, 1990
- Revision received December 10, 1990
- Accepted January 8, 1991
- Published online June 1, 1991.
- Frank D. Kolodgie, MSa,
- Renu Virmani, MD, FACCa,∗,
- J.Fredrick Cornhill, Dphila,†,
- Edward E. Herderick, BSa,† and
- John Smialek, MDa,‡
- ↵∗Address for reprints: Renu Virmani, MD, Department of Cardiovascular Pathology, Armed Forces Institute of Pathology, Building 54, Room 2005, Washington, D.C. 20306-6000.
Coronary vasospasm has been implicated as a cause of myocardial ischemia and sudden cardiac death in cocaine abusers. However, the mechanism or mechanisms remain unknown. Autopsy records (n = 5,871) from the medical examiner's files at Baltimore, Maryland and northern Virginia were examined and 495 persons (8.4%) were identified with positive toxicologic findings for cocaine. Of these, six subjects (1.2%) had total thrombotic occlusion, involving primarily the left anterior descending coronary artery. The mean number of adventitial mast cells per coronary segment and the degree of atherosclerosis were determined. These observations were compared with findings in age- and gender-matched subjects who died from cocaine overdose and in patients who had sudden cardiac death (acute thrombosis) without a history of illicit drug abuse.
There were significantly more mast cells in subjects with cocaine-associated thrombosis than in the other groups. The number of mast cells showed a significant correlation with the degree of cross-sectional luminal narrowing (r = 0.68) in subjects with cocaine-associated thrombosis but not in subjects with sudden death due to thrombosis (r = 0.34, p < 0.03). Subjects with cocaine-associated thrombosis also had significant coronary atherosclerosis without plaque hemorrhage (five had one or more vessels with >75% cross-sectional area luminal narrowing) despite a mean age of 29 ± 2 years.
These findings suggest that adventitial mast cells may potentiate atherosclerosis and vasospasm, thrombosis and premature sudden death in long-term cocaine abusers.
☆ The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the U.S. Army, Navy or Department of Defense.
- Received October 9, 1990.
- Revision received December 10, 1990.
- Accepted January 8, 1991.