Author + information
- Ikechukwu Ifedili,
- Siri Kadire,
- Tamunoinemi Bob-Manuel,
- Britney Heard,
- Leah John,
- Benjamin Zambetti,
- Mark Heckle,
- Fridjof Thomas,
- Showkat Haji,
- Rami Khouzam,
- Guy Reed and
- Uzoma Ibebuogu
Background: More than 500,000 emergency department visits in the United States each year are related to cocaine use. This patient population tends to have a low incidence of a true ST-segment elevation myocardial infarction (STEMI) (0.7% to 6.0%). Identification of the frequency and factors associated with true STEMI in cocaine positive patients presenting with suspected STEMI will lead to an improved decision making management process.
Methods: We performed a retrospective analysis of the 1144 consecutive patients diagnosed with STEMI at our University Hospital from January 2008 to December 2013. A urine drug screen determined cocaine use. True STEMI was defined as having a culprit lesion on coronary angiogram whereas false STEMI was defined as absence of partial or total thrombotic coronary occlusion and/or reduced thrombolysis in myocardial infarction grade flow. Univariate and Multivariate analyses were used to identify risk factors and create a predictive model.
Results: A total of 63 patients with suspected STEMI were cocaine positive with a mean age of 53.1±11.2 years with majority being male (80%). True STEMI was diagnosed in 34 patients while 29 were false STEMI. Cocaine positive true STEMI patients were more likely to be uninsured compared to the false STEMI patients (61.8% vs. 34.5%, p=0.03) and have a higher peak troponin (21.1 ng/mL vs. 2.12 ng/mL respectively, p=<0.01), with no difference in mean age between the two groups (p=0.24). In multivariate analyses, independent predictors of true STEMI in cocaine positive patients included age > 65 (odds ratio [OR] 19.3, 95% CI 1.2-318.3), lack of insurance (OR 4.9, 95% CI 1.2-19.6) and troponin > 0.05 (OR 24.0, 95% CI 2.6-216.8), with all p-values < 0.05. A multivariate risk score created with C-statistic of 82% (95% CI 71-93%) significantly improved the identification of patients with a true STEMI.
Conclusions: In patients with suspected STEMI, cocaine positive patients had a higher incidence of false STEMI. Additionally, older age, lack of insurance and an abnormal troponin were associated with a true STEMI in this group of patients.
Poster Contributions Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Timely Topics in Acute Coronary Syndromes
Abstract Category: 15. Interventional Cardiology: ACS/AMI/Hemodynamics and Pharmacology
Presentation Number: 1242-159
- 2017 American College of Cardiology Foundation