Résumé
Background: The prevalence and prognosis of illicit drug use (IDU) in the setting of acute coronary syndrome (ACS) are poorly documented.
Aim: This study aimed to assess the prevalence of drug use and its potential impact on in-hospital outcomes after ACS.
Methods: The multicenter prospective FRENCHIE cohort of ACS evaluated the prevalence of self-declared drug use and its impact on patients' characteristics and in-hospital outcomes. The composite endpoint of in-hospital outcomes included death, need for intensive care unit, cardiac arrest, sustained ventricular tachycardia, stroke, or stent thrombosis, which was assessed according to drug use status.
Results: Between March 2019 and December 2022, 16,265 ACS patients (53% STEMI) were included in the cohort, with a mean age of 64 ± 13 years, 76% male. IDU was reported by 3% (n=482) of patients. Cannabis and cocaine were the most prevalent drugs, with 438 (91%) and 57 (12%) patients declaring use, respectively. Polydrug use was reported in 51 (11%) patients.
IDUsers were significantly younger than non-drug users (47±10 vs 64±13 years; P<0.0001), more frequently male (91% vs 76%) with fewer traditional cardiovascular risk factors (diabetes, hypertension, dyslipidemia, obesity), and comorbidities (Heart failure, chronic kidney disease, stroke, coronary artery disease). STEMI was more prevalent in IDUsers than in non-users (73% vs 56%;P<0.0001) and initial left ventricular ejection fraction (LVEF) < 40% was more frequent (17.3% vs 13.6%, p= 0.02). The proportion of normal coronary angiogram was similar in both groups, as was patients' presentation (STEMI (1.7% vs 1.0%) or NSTEMI (6.9% vs 5.2%)). The composite in-hospital outcome endpoint rate was similar in both groups (8.7% vs 8.7%, p=0.98). However, in-hospital cardiac arrest (ventricular fibrillation) was twice as high in the IDU group (3.7% vs 1.9%;P<0.006). In multivariate analysis, a history of diabetes, high blood pressure, and an older age were significantly associated with in-hospital outcomes.
Conclusion: In this large contemporary registry, 3% of ACS patients reported IDU, representing the largest population of drug users with ACS studied to date. Despite being much younger, IDUsers had an intra-hospital prognosis comparable to the non-IDU group, with a higher prevalence of decreased LVEF and ventricular fibrillation. Whether the long-term prognosis differs remains to be evaluated.