Marijuana and cocaine use among patients over 50 years old with acute myocardial infarction. Prevalence and in-hospital evolution

Abstract

Introduction: Marijuana and cocaine consumption has increased. There are very few reports revealing cases of >50-year-old patients (pts) who use said drugs and present with acute myocardial infarction. Objectives: 1) To identify >50-year-old marijuana and/or cocaine users presenting
with an acute ST-elevation myocardial infarction (STEMI); 2) to evaluate the characteristics exhibited by said substance users; 3) to analyze in-hospital cardiovascular mortality in comparison to nonusers and identify predictors. Materials and methods: retrospective analysis of >50-year-old pts with acute STEMI having undergone percutaneous coronary intervention (PCI) between April 1st, 2021 and December 31st,2022. Qualitative detection of tetrahydrocannabinol (THC) and benzoylecgonine (COC) in urine was conducted. Two groups of pts were compared: +THC/COC and -THC/COC.Results: 155 pts underwent PCI. +THC/COC test results:16pts(10.32%) tested +THC/COC, 9 pts(56.25 %) tested positive for COC, 4pts(25%) tested positive for THC and 3pts(18.75%) tested positive for both drugs. -THC/COC test results: 139pts (89.68%) tested -THC/COC. Male gender: 93.7% for +THC/COC vs. 83.4% for -THC/COC (p=ns);tobacco use: 81.2% vs 55.4% (p=0.04);thrombus grades 4-5: 56.2%vs16.5% (p=0.02);cardiovascular mortality:6.25% vs5.05% (p=ns), respectively.A multivariate logistic regression analysis indicated that diabetes (p=0.028; OR6.86 CI 95% 1.22-38.4) and Killip-Kimball class C-D on admission (p<0.001;OR 63.9 CI 95% 11.5-354.9) were mortality predictors in the total patient population.Conclusions:1) One in ten >50-year-old pts with STEMI tested +THC/COC;2) +THC/COC pts were closely associated with tobacco use and thrombus burden;3) no significant differences in cardiovascular mortality were found between both groups. Diabetes as well as Killip-Kimball class C-D were identified as predictors of mortality amongst the overall population.