Heart & Vascular Center, Medical University of South Carolina, Charleston, SC, USA.
Atherosclerosis. 2013 Aug;229(2):443-8. doi: 10.1016/j.atherosclerosis.2013.05.032. Epub 2013 Jun 18.
Chest pain associated with cocaine use represents an increasing problem in the emergency department (ED). Cocaine use has been linked to the acute coronary syndrome (ACS) and acute myocardial infarction (AMI). We used coronary computed tomography angiography (cCTA) to evaluate the prevalence, severity and composition of atherosclerotic lesions in cocaine users. We studied 78 patients with non-occasional cocaine use (52 men, 44 ± 7 years, 23 under the acute influence) and acute chest pain but without ACS, who had undergone cCTA in the ED. Patients were matched one-to-one by gender, race, symptoms, and risk-factors with a control cohort (n = 78; 52 men, 45 ± 6 years) not using cocaine. Each coronary segment was evaluated for the presence and composition (calcified, non-calcified, partially calcified) of atherosclerotic plaque and for stenosis. The prevalence of coronary stenosis was not significantly different between patients with and without cocaine use (13% versus 5%, P > 0.05). However, cocaine users on average had significantly more atherosclerotic plaques (0.44 ± 0.88 versus 0.29 ± 0.83, P < 0.05) and a tendency towards more calcified (0.64 ± 1.23 versus 0.55 ± 1.22, P > 0.05) and non-calcified plaques (0.26 ± 0.63 versus 0.17 ± 0.57, P > 0.05), yet not reaching statistical significance. Furthermore, cocaine users had significantly more partially calcified plaques (0.41 ± 0.61 versus 0.17 ± 0.41, P < 0.05) and higher partially calcified plaque volume (59.7 ± 33.3 mm(3) versus 25.6 ± 12.6 mm(3), P < 0.05). Thus, cocaine users tend to have more pronounced coronary atherosclerosis compared to patients without cocaine use at the time of presentation with acute chest pain.
与可卡因使用相关的胸痛在急诊科（ED）中是一个日益严重的问题。可卡因的使用与急性冠状动脉综合征（ACS）和急性心肌梗死（AMI）有关。我们使用冠状动脉计算机断层血管造影（cCTA）来评估可卡因使用者的动脉粥样硬化病变的患病率、严重程度和组成。我们研究了 78 名非偶尔使用可卡因的胸痛患者（52 名男性，44±7 岁，23 名处于急性影响下），并在急诊科进行了 cCTA。根据性别、种族、症状和风险因素，每位患者都与一个对照组（n=78；52 名男性，45±6 岁）进行一对一匹配，这些对照组不使用可卡因。对每个冠状动脉节段进行评估，以确定是否存在动脉粥样硬化斑块及其组成（钙化、非钙化、部分钙化）和狭窄程度。使用可卡因和未使用可卡因的患者之间的冠状动脉狭窄患病率没有显著差异（13%对 5%，P>0.05）。然而，可卡因使用者平均有更多的动脉粥样硬化斑块（0.44±0.88 对 0.29±0.83，P<0.05），且倾向于有更多的钙化斑块（0.64±1.23 对 0.55±1.22，P>0.05）和非钙化斑块（0.26±0.63 对 0.17±0.57，P>0.05），但未达到统计学意义。此外，可卡因使用者有更多的部分钙化斑块（0.41±0.61 对 0.17±0.41，P<0.05）和更高的部分钙化斑块体积（59.7±33.3mm3 对 25.6±12.6mm3，P<0.05）。因此，与急性胸痛就诊时不使用可卡因的患者相比，可卡因使用者在就诊时更倾向于有明显的冠状动脉粥样硬化。
