Prevalence and prognosis of illicit drug use in patients admitted for myocardial infarction: a prospective multicenter study

Abstract Background The prevalence and impact of illicit drug use (IDU) in acute coronary syndrome (ACS) remain poorly documented. Purposes The primary aim was to assess the prevalence of drug use and its impact on in-hospital outcomes after ACS. The secondary aim was to evaluate in-hospital prognosis in patients with ST-elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI). Methods This study analyzed data from the FRENCHIE multicenter prospective ACS cohort (February 2019–December 2022). The primary endpoint was a composite of all-cause death and cardiac arrest. Results Among 16,132 ACS patients (mean age 64 ± 13 years, 76% male), 3% (n=478) reported IDU (Figure 1), primarily cannabis (91%) and cocaine (12%), with 11% using multiple substances. IDUsers were younger (47 ± 10 vs. 64 ± 13 years, P0.0001), predominantly male (91% vs. 76%), and had less comorbidities (Heart failure, chronic kidney disease, stroke, coronary artery disease), and fewer cardiovascular risk factors, except for active smoking (92% vs. 34%, P0.0001). The proportion of normal coronary angiogram was not statistically different in both groups, neither were troponin levels at admission. The composite in-hospital outcome occurred in 632 patients (4.2% in IDUsers vs. 3.9% in non-users, P=0.76). In multivariate analysis, IDU was an independent predictor of in-hospital outcomes (adjusted OR 1.84, 95% CI 1.14–2.98, P=0.001) (Figure 2). After propensity score (PS) matching for age, sex, obesity, diabetes, hypertension, smoking, and AMI type, IDU remained significantly associated with worse in-hospital outcomes (OR 1.95, 95% CI 1.04–3.63, P=0.036). Among 9,166 STEMI patients, 4% (n=348) reported IDU, with 92% male and a mean age of 42 ± 9 years. The in-hospital composite outcome occurred in 5.4%. IDU was independently predictive of in-hospital outcomes, both in the overall STEMI group (adjusted OR 2.03, 95% CI 1.24–3.31, P=0.005) and after PS matching (OR 1.96, 95% CI 1.05–3.67, P=0.035). Among 6,966 NSTEMI patients, 1.9% (n=130) were IDUsers, with no deaths or cardiac arrests recorded in this group. Conclusion In this multicenter registry, 3% of patients reported IDU, making it the largest cohort of drug users with ACS studied to date. IDU was an independent predictor of in-hospital death or cardiac arrest, both in the entire population and in STEMI patients. The impact on long-term prognosis warrants further investigation.Flow Chart