Forensic Pathology Service, Institute of Legal Medicine, Seville, Spain.
Eur Heart J. 2010 Feb;31(3):318-29. doi: 10.1093/eurheartj/ehp557. Epub 2010 Jan 12.
With an estimated 12 million consumers in Europe, cocaine (COC) is the illicit drug leading to the most emergency department visits. The aim of this study was to examine a consecutive series of sudden deaths (SDs) to focus on the prevalence, the toxicological characteristics, and the causes of death in COC-related fatalities.
Prospective case-control study of forensic autopsies was carried out in the time interval November 2003 to June 2006 at the Institute of Legal Medicine, Seville, south-west Spain, with a reference population of 1 875 462 inhabitants. Toxicology included blood ethanol analysis and blood and urine investigation for drugs of abuse and medical drugs. Autopsy was performed according to the European standardized protocol. Ten age- and sex-matched patients who died of violent causes with no antecedents of COC consumption and negative toxicology served as controls. During the study period, 2477 forensic autopsies were performed, including 1114 natural deaths. Among the latter, 668 fulfilled the criteria of SD and 21 (all males, mean age 34.6 +/- 7.3 years) resulted to be COC-related (3.1%). Cocaine was detected in 67.1% of the blood (median 0.17 mg/L, interquartile range 0.08-0.42) and in 83.0% of the urine samples (median 1.15 mg/L, interquartile range 0.37-17.34). A concomitant use of ethanol was found in 76.0% and cigarette smoking in 81.0%. Causes of SD were cardiovascular in 62.0%, cerebrovascular in 14.0%, excited delirium in 14.0%, respiratory and metabolic in 5.0% each. Left ventricular hypertrophy was observed in 57.0%, small vessels disease in 42.9%, severe atherosclerotic coronary artery disease in 28.6%, and coronary thrombosis in 14.3%.
Systematic toxicology investigation indicates that 3.1% of SDs are COC-related and are mainly due to cardio-cerebrovascular causes. Left ventricular hypertrophy, small vessel disease, and premature coronary artery atherosclerosis, with or without lumen thrombosis, are frequent findings that may account for myocardial ischaemia at risk of cardiac arrest in COC addicts.
在欧洲，估计有 1200 万消费者使用可卡因（COC），这是导致急诊就诊人数最多的非法药物。本研究的目的是检查一系列连续的猝死（SD），以关注与 COC 相关的致命性药物的流行率、毒理学特征和死因。
在西班牙西南部塞维利亚的法医学研究所进行了一项前瞻性病例对照研究，时间区间为 2003 年 11 月至 2006 年 6 月，参考人群为 1875462 名居民。毒理学检测包括血液乙醇分析以及血液和尿液中滥用药物和医疗药物的检测。尸检按照欧洲标准化协议进行。10 名年龄和性别匹配的死于暴力原因且无 COC 消费史和阴性毒理学结果的患者作为对照组。在研究期间，共进行了 2477 次法医解剖，其中包括 1114 例自然死亡。在后者中，668 例符合 SD 标准，其中 21 例（均为男性，平均年龄 34.6+/-7.3 岁）被证实与 COC 相关（3.1%）。可卡因在 67.1%的血液（中位数 0.17mg/L，四分位距 0.08-0.42）和 83.0%的尿液样本中（中位数 1.15mg/L，四分位距 0.37-17.34）被检出。76.0%的患者同时使用乙醇，81.0%的患者吸烟。SD 的原因是心血管 62.0%、脑血管 14.0%、兴奋性谵妄 14.0%、呼吸和代谢各 5.0%。左心室肥厚占 57.0%，小血管疾病占 42.9%，严重动脉粥样硬化性冠状动脉疾病占 28.6%，冠状动脉血栓形成占 14.3%。
系统毒理学调查表明，3.1%的 SD 与 COC 相关，主要是由于心脑血管原因。左心室肥厚、小血管疾病和冠状动脉粥样硬化提前发生，无论是否伴有管腔血栓形成，在 COC 成瘾者中可能导致心肌缺血并容易发生心搏骤停。
