Dr. Mirailles stated, “Among patients admitted to the intensive cardiac care unit (ICCU), systematic screening for recreational drugs evidenced a significant prevalence—11%—of recent use.” He added, “Recreational drug use was associated with triple the risk of a repeat serious cardiovascular event within 1 year.”
Previous work by the research group revealed that a recent history of recreational drug use was related to a higher rate of in-hospital outcomes; however, long-term cardiovascular consequences of recreational drug use remain indeterminate.
In this study, Dr. Mirailles and colleagues sought to assess the prognostic impact of recreational drug use at the 1-year follow-up to predict serious cardiovascular events (including mortality) in consecutive patients admitted to ICCUs for acute cardiovascular events from Addiction in Intensive Cardiac Care Units (ADDICT-ICCU) study.
Of the 1,499 consecutive patients screened, 1,392 (93%) patients (mean age 63 years, 70% males) had a complete 1-year follow-up. The researchers examined data from 1,392 consecutive patients admitted to the ICCU at 39 centers in France over a 2-week period in April 2021. The 1-year follow-up comprised a clinical visit or direct contact with the patient and the referring cardiologist. The primary composite outcome was the incidence of a serious cardiac event—cardiovascular death, nonfatal heart attack (myocardial infarction), or stroke. Subgroup analysis was executed in patients hospitalized at baseline for acute coronary syndrome (nonfatal heart attack/angina lasting more than 20 minutes).
Patients who died during hospitalization, had a planned interventional procedure, or were admitted to the ICCU more than 24 hours after admission were excluded from the study.
Among the 1,392 patients, 157 patients (11%) tested positive for recreational drug use, including cannabis (9.8%), heroin and opioids (2.3%), cocaine (1.7%), and amphetamines (0.6%), and 3,4-methylenedioxymethamphetamine (MDMA; 0.6%). Notably, 28.7% of these patients tested positive for two or more drugs.
After 1 year, 94 patients (7%) experienced serious cardiovascular events, including death, with a greater rate among drug users (13%) compared with nonusers (6%). After adjusting for various factors, recreational drug use was independently associated with a threefold increase in the risk of serious cardiovascular events.
In a subgroup of 713 patients hospitalized for acute coronary syndrome, 96 (14%) tested positive for recreational drugs and 50 (7%) experienced serious cardiovascular events. Recreational drug use remained independently associated with a threefold increase in risk after adjustment.
Among the 1,392 patients, there were 64 cardiovascular deaths (4.6%), with 4.5% among nonusers and 5.7% among drug users. Nonfatal heart attacks occurred in 24 patients (1.7%), with 16 (1.3%) among nonusers and 8 (5.1%) among drug users. Strokes occurred in 10 patients (0.7%), with 7 (0.6%) among nonusers and 3 (1.9%) among drug users.
Among recreational drugs tested, MDMA (4.1 times augmented risk), heroin and opioids (3.6 times), and cannabis (1.8 times) were significantly linked with serious cardiovascular events, while other drugs did not show a statistically significant relationship.
Dr. Mirailles stated, “ln a large cohort of consecutive patients admitted to intensive care cardiac units for acute cardiovascular events, the prevalence of recreational drug use was 11%. Recreational drug use was associated with a tripling of the risk of a repeat serious cardiovascular event within one year.”
He added, “There is an increasing amount of data regarding the worst prognosis associated with recreational drug use, not only in cardiac intensive care units but also in conventional intensive care units. Despite the high rate of underreporting of recreational drug use, systematic screening is not recommended by the current guidelines. It might improve the risk stratification of patients and personalized care to favor drug withdrawal. Therefore, systemic screening should be considered in intensive care.”
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