Prognosis of illicit drug use in patients with acute ST-elevation myocardial infarction: Insights from the ADDICT-ICCU trial

Introduction Although illicit drug use may induce ST-elevated myocardial infarction (STEMI), its prevalence in patients hospitalized in intensive cardiac care units (ICCUs) for STEMI, as well as its short-term cardiovascular consequences, remain unknown. Objective To assess the prevalence of illicit drug use and its prognostic value to predict the occurrence of in-hospital major adverse cardiac events (MAEs) in STEMI patients admitted to the intensive cardiac care unit (ICCU). Method From 7 to 22 April 2021, screening for illicit drug was performed prospectively by systematic urinary testing in all consecutive patients admitted for STEMI in 39 centres throughout France. The primary endpoint was the prevalence of the illicit drugs detected. The secondary outcome was MAEs defined by death, resuscitated cardiac arrest or cardiogenic shock. Results Among 342 consecutive patients admitted for STEMI (age 62±13years, 79% male), 43 (12.1%) had a positive test (cannabis: 88%, opioids: 36%, cocaine: 10%, 3,4-methylenedioxymethamphetamine: 5%). Patients with illicit drug use were more frequently male (93% vs. 77%, P=0.02), younger (50±12years vs. 63±13, P<0.001). Active smoking was more frequent (78% vs. 34%. P<0.001). After a median duration of hospitalisation of 4.5days, 17 in-hospital MAEs occurred (5.2%). The detection of illicit drugs was associated with a higher rate of MAEs after adjustment for known comorbidities (OR=13.1; 95% CI: 3.44–54.6), for known predictors of severity on admission (OR=30.0; 95% CI: 6.08–184), or after using a propensity score adjustment (OR=14.3; 95% CI: 3.55–61.0, all P<0.001). High-sensitivity cardiac troponin peak and left ventricular ejection fraction assessing the infarct size were higher in patients illicit drug use compared to others (P<0.001) (Fig. 1). Conclusion The prevalence of illicit drug use in patients hospitalized for STEMI was 12.1%. Illicit drugs detection was independently associated with a higher occurrence of in-hospital MAEs, despite a younger population, with less comorbidities.