Findings from a new study show that Illicit drug use is associated with a nearly 9-fold greater risk of death or life-threatening emergencies in intensive cardiac care unit (ICCU) patients, according to research presented at ESC Congress on 26 August, 2022 in Barcelona, Spain .
Dr. Theo Pezel (Hospital Lariboisiere, Paris, France) presented the results of the Addiction in Intensive Cardiac Care Units (ADDICT-ICCU; NCT05063097) study, which assessed the prevalence of illicit drug use and the association with in-hospital major adverse events in consecutive patients admitted for acute cardiovascular events. From 7 to 22 April 2021, all consecutive patients admitted to ICCU in 39 centres throughout France provided a urine sample which was tested for illegal drugs. The primary outcome was the prevalence of illegal drug use. The secondary outcome was in-hospital major adverse events, defined as death, resuscitated cardiac arrest or cardiogenic shock.
A total of 1,499 patients were screened, of which 70% were men, with an average age of 63 years. Reasons for admission included myocardial infarction, acute heart failure, arrhythmias, myocarditis and pulmonary embolism. Some 161 patients (10.7%) had a positive test for at least 1 illicit drug: 9.1% tested positive for cannabis, 2.1% for opioids, 1.7% for cocaine, 0.7% for amphetamines and 0.6% for MDMA.
Patients who used illicit drugs tended to be young: 33% of patients under 40 years of age were users compared with just 6% of those aged 60 years or above. Some 12% of men were users compared to 8% of women. All patients completed a questionnaire in which they were asked if they currently used illicit drugs. Of those with a positive urine drug test, just 56.5% reported current use while 43.5% claimed they did not use drugs.
During a median hospitalisation of 5 days, 61 patients (4.1%) had a major adverse event. Illicit drug use was associated with an almost 9-fold odds of major adverse events after adjusting for comorbidities (OR 8.84; 95% CI 4.68–16.7; P<0.001). After adjustment for age and sex, cannabis use was associated with over a 3-fold odds of major adverse events (OR 3.53; 95% CI 1.25–9.95; P<0.001) while cocaine was associated with over a 5-fold risk (OR 5.12; 95% CI 1.48–17.2; P=0.004). Multiple drug use (28% of all cases)was associated with a higher incidence of major adverse events than single drug use (OR 11.4; 95% CI 4.31–32.7; P<0.001).
Dr. Pezel said: “Illicit drug use was common in ICCU patients but under-reported. Users admitted for ST-elevation myocardial infarction (STEMI) and acute heart failure had particularly high risks of death, cardiac arrest or cardiogenic shock with odds ratios of 28.8 and 12.8, respectively. Our results suggest that patients admitted to ICCU should be tested for drugs to identify those with an increased likelihood of detrimental outcomes.”
- Pezel T et al. Prevalence of illicit drugs use and association with in-hospital major adverse events in patients hospitalised for acute cardiac events: the ADDICT-ICCU Trial ESC Congress, 26-29 August 2022, Barcelona, Spain.
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