Author + information
- Peter Moorea,b,
- Kara L. Lyncha,b,
- Alan H.B. Wua,b,
- Yifei Maa,b,
- Rebecca Scherzera,b,
- Danny Lia,b and
- Elise D. Rileya,b
Background: In the absence of acute MI, cocaine use has not been significantly associated with elevations in serum troponin. The relationship between amphetamine and troponin levels remains unknown.
Methods: Cross-sectional study of patients at a San Francisco emergency department who had cardiac troponin I (cTnI) and urine toxicology obtained as part of clinical care from May 2015 to May 2016. Those with alternate cause of cTnI elevation were excluded. Three groups were established: cocaine positive (C, n=102), amphetamine positive (A, n=102), neither positive (N, n=94). Elevated cTnI was defined as ≥0.04 ng/ml (99th percentile in a healthy population).
Results: The median age was 55 and 78% were male. Median cTnI levels did not differ significantly between the groups. The prevalence of elevated cTnI was higher in group C (41%) relative to groups A (29%) and N (29%), but did not reach statistical significance (p=0.09). When group C was stratified by serum levels of cocaine and its metabolite, benzoylecgonine, higher concentrations were associated with cTnI elevation (Figure, 3rd tertile compared to undetectable, OR 3.0, p=0.004) In contrast, in group A the highest serum amphetamine tertile had an inverse association with cTnI elevation.
Conclusions: Higher serum levels of cocaine and metabolites were predictive of cTnI elevation while amphetamine levels displayed an inverse association. Larger doses of cocaine may correlate with higher markers of cardiac injury and may predispose to increased CV mortality.
Poster Hall, Hall C
Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Unusual Presentations of ACS
Abstract Category: 2. Acute and Stable Ischemic Heart Disease: Clinical
Presentation Number: 1297-327
- 2017 American College of Cardiology Foundation