Prognostic Impact of Recreational Drug Use on 1-Year Outcomes in NSTEMI and STEMI Patients
2 MASCOT (UMR_S_942 / U942) - Marqueurs cardiovasculaires en situation de stress
3 USF - University of South Florida [Tampa]
4 CHRU Nancy - Centre Hospitalier Régional Universitaire de Nancy
5 IADI - Imagerie Adaptative Diagnostique et Interventionnelle
6 CHU Strasbourg - Centre Hospitalier Universitaire [Strasbourg]
7 CHU de Poitiers [La Milétrie] - Centre hospitalier universitaire de Poitiers = Poitiers University Hospital
8 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
9 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
10 Hôpital d'instruction des Armées Percy
11 Centre hospitalier Félix-Guyon [Saint-Denis, La Réunion]
12 Hôpital Haut-Lévêque [CHU Bordeaux]
13 CRCTB - Centre de recherche Cardio-Thoracique de Bordeaux [Bordeaux]
14 Groupe Hospitalier Intercommunal Le Raincy-Montfermeil
15 Hôpitaux de Chartres [Chartres]
16 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
17 Centre Hospitalier d'Annecy Genevois
18 CH Avignon - Centre Hospitalier Henri Duffaut [Avignon]
19 EnVI - Endothélium, valvulopathies et insuffisance cardiaque
20 CHU Rouen
21 CHU Amiens-Picardie
22 CHU Clermont-Ferrand
23 ULB - Université libre de Bruxelles = Free University of Brussels
24 HUB-ULB - Hôpital Erasme = Erasmus Hospital = Erasmus Ziekenhuis
25 Hôpital Cochin [AP-HP]
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Résumé
Background: Recreational drug use is increasingly associated with adverse outcomes in acute coronary syndrome (ACS) patients, but differences in long-term outcomes between ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction are not well defined. Objective: The authors evaluated the association between recreational drug use and major adverse cardiovascular events (MACE) 1 year after intensive cardiac care unit (ICCU) admission in ACS patients. Methods: The Addiction in Intensive Cardiac Care Units study systematically screened all patients admitted to ICCUs across 39 French centers (April 7-22, 2021) via prospective urinary testing. The primary outcome was MACE, defined as cardiovascular death, nonfatal myocardial infarction, or stroke. One-year follow-up was collected through clinical visits or direct contact between patients and cardiologists, concluding in June 2022. Outcomes were adjudicated by an independent cardiology committee. The prognostic impact of recreational drug use on MACE was assessed using multivariable Cox proportional hazards models, validated by propensity matching. Results: Of 712 ACS patients, 13.5% had recreational drug detection. At 1 year, MACE occurred in 7.0%, with higher rates among drug-positive vs drug-negative patients (12.5% vs 6.2%). Recreational drug use was associated with increased MACE (HR: 2.70; 95% CI: 1.30-5.57; P = 0.013). This association was significant in STEMI (HR: 4.11; 95% CI: 1.60-10.5; P = 0.005) but not in non-ST-elevation myocardial infarction patients. Propensity matching confirmed this in STEMI patients (HR: 3.39; 95% CI: 1.19-9.62; P = 0.022). Conclusions: Recreational drug use was associated with increased 1-year MACE risk in ACS patients, particularly STEMI, supporting routine drug screening.