Hospital outcome of cocaine use in young adults with acute myocardial infarction: A National Inpatient Perspective

Abstract Background Cocaine remains the most commonly used illicit stimulant in the United States, with young adults constituting the highest-risk population. This is a known trigger for acute myocardial infarction (AMI), even in individuals without traditional cardiovascular risk factors. Recent epidemiological data highlight an alarming trend: between 2022 and 2023, the rate of deaths involving cocaine rose by 4.9%. This study aims to analyze national inpatient data to assess trends in mortality among young adults hospitalized with AMI and a history of cocaine use. Method This retrospective cohort study used the National Inpatient Sample (NIS) (2016–2022) to analyze young adults 18 to 40 years) hospitalized with a primary diagnosis of acute myocardial infarct (AMI). Patients were categorized into two cohorts: AMI with history of cocaine use and AMI without history of cocaine use, identified using ICD-10 codes. The primary outcome was all-cause inpatient mortality, while secondary outcomes included length of stay (LOS) and total hospital charges. Patient demographics were obtained, and χ² tests were used for categorical variables, while t-tests were applied to continuous variables. Multivariate logistic regression estimated adjusted odds ratios (aORs) for inpatient mortality, adjusting for age, sex, race, insurance type, household income, Charlson Comorbidity Index (CCI), hospital bed size, teaching status, and geographic region. A two-sided p-value 0.05 was considered statistically significant. Results The mean age of patients was 34 years. Young adults with acute myocardial infarction who use cocaine are more likely to be male (74.6% vs. 65.3%; p 0.001), African American (40.2% vs. 26.8%; p 0.001), and from low-income backgrounds. The duration of hospitalization and in-hospital mortality rates were comparable between the two groups, with both averaging around three days (p = 0.297) and having a fatality rate of approximately 1% (p = 0.205). Concerning clinical outcomes and healthcare resource use, cocaine consumption was not a significant determinant of mortality, hospital stay duration, or overall medical expenses. Age was linked to higher hospital expenditures (coefficient: 1200; p 0.001), while ethnicity also played a role in cost variations, with Hispanic patients incurring greater charges (coefficient: 14,050; p 0.001) and African American patients having lower expenses (coefficient: -5552; p = 0.011). Conclusion This study suggests that socioeconomic factors, hospital characteristics, and comorbidities, rather than cocaine use itself, play a more prominent role in determining hospital outcomes and costs for young adults with AMI.