Association Between Recreational Drug Use and Cardiovascular Events Post-Hospitalization in France

BACKGROUND: Although recent work has shown that recent recreational drug use is associated with in-hospital outcomes in patients admitted to the intensive cardiac care unit (ICCU), its cardiovascular consequences after hospitalization for an acute cardiovascular event are not well established. We aimed to evaluate the prognostic impact of recreational drug use at 1-year follow-up on major adverse cardiovascular and cerebrovascular events (MACCE) in patients admitted to the ICCU. METHODS: The ADDICT-ICCU study (Addiction in Intensive Cardiac Care Units) is a prospective multicentric study including all consecutive patients admitted to the ICCU over 2 weeks in April 2021 at 39 French centers. Patients were excluded in cases of scheduled hospitalization, hospitalization within 24 hours before ICCU admission, or in-hospital death. Screening for recreational drug use was performed by a systematic urinary testing upon admission. The primary composite outcome was 1-year MACCE defined as cardiovascular death, nonfatal myocardial infarction, or stroke. Outcomes were adjudicated by 2 senior cardiologists after patient contact and review of anonymized records. A multivariable Cox regression analysis adjusted for traditional prognostic factors was performed to assess the independent association between overall recreational drug use and clinical outcomes. RESULTS: Of the 1392 patients assessed (63±15 years, 69.9% men), 157 (11.3%) had an initial positive test (cannabis or opioids, cocaine, amphetamines, or 3,4-methylenedioxymethamphetamine). After 1-year of follow-up, 94 (6.7%) patients experienced MACCE, with a higher incidence observed among drug users compared with nonusers (12.7% versus 6.0%; risk difference, 6.7% [95% CI, 1.5%-12.2%]). Cannabis or opioid use alone was also associated with MACCE (hazard ratio, 1.77 [95% CI, 1.02-3.08] for cannabis, and hazard ratio, 3.60 [95% CI, 1.57-8.23], for opioids). After adjustment for traditional prognostic factors, recreational drug use remained independently associated with MACCE (hazard ratio, 2.91 [95% CI, 1.68-5.05]). CONCLUSIONS: Recreational drug use markedly increases the risk of 1-year adverse cardiovascular outcomes in ICCU patients highlighting the need for targeted, tailored interventions. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT05063097.