Service de cardiologie, CHU Trousseau, 37044 Tours, France.
Université de Tours, EA7505, 37044 Tours, France.
Eur Heart J Acute Cardiovasc Care. 2021 Dec 6;10(9):1027-1037. doi: 10.1093/ehjacc/zuab073.
Several reports suggest that illicit drug use may be a major cause of acute myocardial infarction (AMI) independently of smoking habits and associated with a poorer prognosis. The aim of our study was to evaluate the impact of illicit drug use on (i) the risk of AMI and (ii) its prognosis.
This French longitudinal cohort study was based on the administrative hospital-discharge database from the entire population. First, we collected data for all patients admitted in hospital in 2013 with at least 5 years of follow-up to identify potential predictors of AMI. In a second phase, we collected data for all patients admitted with AMI from January 2010 to December 2018. We identified patients with a history of illicit drug use (cannabis, cocaine, or opioid). These patients were matched with patients without illicit drug use to assess their prognosis. In 2013, 3 381 472 patients were hospitalized with a mean follow-up of 4.7 ± 1.8 years. In multivariable analysis, among all drugs under evaluation, only cannabis use was significantly associated with a higher risk of AMI [HR 1.32 (95% CI 1.09-1.59), P = 0.004]. Between January 2010 and December 2018, we then identified 738 899 AMI patients. Among these patients, 3827 (0.5%) had a known history of illicit drug use. These patients were younger, most often male and had less comorbidities. After 1:1 propensity score matching, during a mean follow-up of 1.9 ± 2.3 years, there was no significant difference between patients without illicit drug use and patients with illicit drug use regarding all-cause death, cardiovascular death, stroke, or heart failure.
In a large and systematic nationwide analysis, cannabis use was an independent risk factor for the incidence of AMI. However, the prognosis of illicit drug users presenting with AMI was similar to patients without illicit drug use.
有几项报告表明，非法药物的使用可能是急性心肌梗死（AMI）的一个主要原因，且独立于吸烟习惯，并与更差的预后相关。本研究的目的是评估非法药物的使用对（i）AMI 风险和（ii）其预后的影响。
本研究是一项基于法国纵向队列研究，数据来自整个人群的医院出院管理数据库。首先，我们收集了 2013 年所有至少随访 5 年的住院患者的数据，以确定 AMI 的潜在预测因素。在第二阶段，我们收集了 2010 年 1 月至 2018 年 12 月所有因 AMI 住院的患者的数据。我们确定了有非法药物使用史（大麻、可卡因或阿片类药物）的患者。这些患者与无非法药物使用史的患者进行匹配，以评估他们的预后。2013 年，3381472 名患者住院，平均随访 4.7±1.8 年。多变量分析中，在所评估的所有药物中，只有大麻的使用与 AMI 的风险增加显著相关[风险比 1.32（95%置信区间 1.09-1.59），P=0.004]。2010 年 1 月至 2018 年 12 月期间，我们随后确定了 738899 例 AMI 患者。其中 3827 例（0.5%）有已知的非法药物使用史。这些患者更年轻，大多数为男性，合并症更少。在进行 1:1 倾向评分匹配后，在平均 1.9±2.3 年的随访期间，无非法药物使用史的患者和有非法药物使用史的患者在全因死亡、心血管死亡、卒中和心力衰竭方面没有显著差异。
在一项大规模的系统的全国性分析中，大麻的使用是 AMI 发生率的一个独立危险因素。然而，AMI 患者中非法药物使用者的预后与无非法药物使用者相似。
