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Background <p>Cocaine is a global health burden and the cause of a significant number of emergency department consultations. Its association with acute myocardial infarction (AMI) is known, however, data are still rare. The aim of this study was to define causative pathologies behind cocaine-induced AMI (CI-AMI) and to analyze their clinical features.</p> Methods <p>Patients with the diagnosis of CI-AMI were retrospectively identified at the University Hospital Zurich between 1997 and 2023. The angiograms were reviewed to confirm the diagnosis. Coronary microvascular dysfunction (CMD) was separately evaluated by an angiography-based analysis (AngioPlus Core, Microport Medical Co.). The primary endpoint was rates of major adverse cardiovascular events (MACE) at 30&#xa0;days, 1 year, and 2 years.</p> Results <p>Forty-five cases of CI-AMI were identified. Twelve patients (27%) were diagnosed with plaque rupture and intraluminal thrombus, eight (18%) with coronary artery disease (CAD) without thrombus formation, eight (18%) with spontaneous coronary artery dissection, six (13%) with CMD, four (9%) with coronary vasospasm, and four patients (9%) with Takotsubo syndrome. The cause of CI-AMI remained unclear in three patients (6%). No clinically useful predictors of CAD were identified. 91% of patients had values associated with CMD during angiography-based analysis, independently from the etiology of CI-AMI. 49% of cases were treated by revascularization, and the number of MACE was high (16%, 28%, and 34%&#xa0;at 30 days, 1 year, and 2 years).</p> Conclusions <p>CI-AMI is a rare, but important cause of acute coronary syndromes (ACS). CAD represents the most frequent etiology of AMI, but there is a broad range of other entities. Patients suffer from a significant number of adverse events.</p> Graphical abstract <p></p> <p>A broad variety of etiologies of acute myocardial infarction was found among patients with cocaine-induced acute myocardial infarction. The most common etiology was atherosclerotic coronary artery disease with or without intraluminal thrombus formation. However, slightly more than half of the patients presented with non-atherosclerotic causes of myocardial infarction. Among those, spontaneous coronary artery dissection and coronary vasospasm were found as epicardial diseases, and coronary microvascular dysfunction and Takotsubo syndrome as microvascular effects of cocaine consumption. This variety can be explained by the multifold pathophysiological mechanisms of cocaine. It is known as a risk factor for premature atherosclerosis and as a potent sympathomimetic, which leads to elevated blood pressure, inotropy, increased heart rate, and vasoconstriction. Increased shear stress might provoke plaque rupture and spontaneous coronary artery dissection. Furthermore, cocaine is known as a prothrombotic agent. Supply–demand mismatch and superimposed vasospasm are reasons for myocardial infarction in coronary artery disease without thrombus formation. Microvascular vasospasm and endothelial dysfunction might cause coronary microvascular dysfunction and Takotsubo syndrome after cocaine consumption.</p>

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Cocaine-induced acute myocardial infarction: angiographic features and outcomes

  • 期刊论文

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  • 发表日期：

    2025年5月27日

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  • Michael Würdinger,
  • Davide Di Vece,
  • Victor Schweiger,
  • Iva Koleva,
  • Barbara E. Stähli,
  • Jelena-Rima Ghadri,
  • Erik W. Holy,
  • Christian Templin

摘要

Background

Cocaine is a global health burden and the cause of a significant number of emergency department consultations. Its association with acute myocardial infarction (AMI) is known, however, data are still rare. The aim of this study was to define causative pathologies behind cocaine-induced AMI (CI-AMI) and to analyze their clinical features.

Methods

Patients with the diagnosis of CI-AMI were retrospectively identified at the University Hospital Zurich between 1997 and 2023. The angiograms were reviewed to confirm the diagnosis. Coronary microvascular dysfunction (CMD) was separately evaluated by an angiography-based analysis (AngioPlus Core, Microport Medical Co.). The primary endpoint was rates of major adverse cardiovascular events (MACE) at 30 days, 1 year, and 2 years.

Results

Forty-five cases of CI-AMI were identified. Twelve patients (27%) were diagnosed with plaque rupture and intraluminal thrombus, eight (18%) with coronary artery disease (CAD) without thrombus formation, eight (18%) with spontaneous coronary artery dissection, six (13%) with CMD, four (9%) with coronary vasospasm, and four patients (9%) with Takotsubo syndrome. The cause of CI-AMI remained unclear in three patients (6%). No clinically useful predictors of CAD were identified. 91% of patients had values associated with CMD during angiography-based analysis, independently from the etiology of CI-AMI. 49% of cases were treated by revascularization, and the number of MACE was high (16%, 28%, and 34% at 30 days, 1 year, and 2 years).

Conclusions

CI-AMI is a rare, but important cause of acute coronary syndromes (ACS). CAD represents the most frequent etiology of AMI, but there is a broad range of other entities. Patients suffer from a significant number of adverse events.

Graphical abstract

A broad variety of etiologies of acute myocardial infarction was found among patients with cocaine-induced acute myocardial infarction. The most common etiology was atherosclerotic coronary artery disease with or without intraluminal thrombus formation. However, slightly more than half of the patients presented with non-atherosclerotic causes of myocardial infarction. Among those, spontaneous coronary artery dissection and coronary vasospasm were found as epicardial diseases, and coronary microvascular dysfunction and Takotsubo syndrome as microvascular effects of cocaine consumption. This variety can be explained by the multifold pathophysiological mechanisms of cocaine. It is known as a risk factor for premature atherosclerosis and as a potent sympathomimetic, which leads to elevated blood pressure, inotropy, increased heart rate, and vasoconstriction. Increased shear stress might provoke plaque rupture and spontaneous coronary artery dissection. Furthermore, cocaine is known as a prothrombotic agent. Supply–demand mismatch and superimposed vasospasm are reasons for myocardial infarction in coronary artery disease without thrombus formation. Microvascular vasospasm and endothelial dysfunction might cause coronary microvascular dysfunction and Takotsubo syndrome after cocaine consumption.