急性心血管事件患者中消遣性药物使用的患病率及影响
Prevalence and impact of recreational drug use in patients with acute cardiovascular events.
作者信息
Pezel Théo, Dillinger Jean-Guillaume, Trimaille Antonin, Delmas Clément, Piliero Nicolas, Bouleti Claire, Pommier Thibaut, El Ouahidi Amine, Andrieu Stéphane, Lattuca Benoit, Rossanaly Vasram Reza, Fard Damien, Noirclerc Nathalie, Bonnet Guillaume, Goralski Marc, Elbaz Meyer, Deney Antoine, Schurtz Guillaume, Docq Clemence, Roubille Francois, Fauvel Charles, Bochaton Thomas, Aboyans Victor, Boccara Franck, Puymirat Etienne, Batisse Anne, Steg Gabriel, Vicaut Eric, Henry Patrick
机构信息
Department of Cardiology, Hôpital Lariboisière, Assistance Publique - Hopitaux de Paris, Université Paris Cité, INSERM U 942, Paris, France.
Department of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France.
出版信息
Heart. 2023 Oct 12;109(21):1608-1616. doi: 10.1136/heartjnl-2023-322520.
OBJECTIVE
While recreational drug use is a risk factor for cardiovascular events, its exact prevalence and prognostic impact in patients admitted for these events are not established. We aimed to assess the prevalence of recreational drug use and its association with in-hospital major adverse events (MAEs) in patients admitted to intensive cardiac care units (ICCU).
METHODS
In the Addiction in Intensive Cardiac Care Units (ADDICT-ICCU) study, systematic screening for recreational drugs was performed by prospective urinary testing all patients admitted to ICCU in 39 French centres from 7 to 22 April 2021. The primary outcome was prevalence of recreational drug detection. In-hospital MAEs were defined by death, resuscitated cardiac arrest, or haemodynamic shock.
RESULTS
Of 1499 consecutive patients (63±15 years, 70% male), 161 (11%) had a positive test for recreational drugs (cannabis 9.1%, opioids 2.1%, cocaine 1.7%, amphetamines 0.7%, 3,4-methylenedioxymethamphetamine (MDMA) 0.6%). Only 57% of these patients declared recreational drug use. Patients who used recreational drugs exhibited a higher MAE rate than others (13% vs 3%, respectively, p<0.001). Recreational drugs were associated with a higher rate of in-hospital MAEs after adjustment for comorbidities (OR 8.84, 95% CI 4.68 to 16.7, p<0.001). After adjustment, cannabis, cocaine, and MDMA, assessed separately, were independently associated with in-hospital MAEs. Multiple drug detection was frequent (28% of positive patients) and associated with an even higher incidence of MAEs (OR 12.7, 95% CI 4.80 to 35.6, p<0.001).
CONCLUSION
The prevalence of recreational drug use in patients hospitalised in ICCU was 11%. Recreational drug detection was independently associated with worse in-hospital outcomes.
CLINICAL TRIAL REGISTRATION
NCT05063097.
目的
虽然使用消遣性药物是心血管事件的一个风险因素，但其在因这些事件入院的患者中的确切患病率及其预后影响尚未确定。我们旨在评估入住重症心脏监护病房（ICCU）的患者中消遣性药物使用的患病率及其与院内主要不良事件（MAE）的关联。
方法
在重症心脏监护病房成瘾（ADDICT - ICCU）研究中，于2021年4月7日至22日对法国39个中心入住ICCU的所有患者进行前瞻性尿液检测，以系统筛查消遣性药物。主要结局是消遣性药物检测的患病率。院内MAE定义为死亡、复苏的心脏骤停或血流动力学休克。
结果
在1499例连续患者（63±15岁，70%为男性）中，161例（11%）消遣性药物检测呈阳性（大麻9.1%，阿片类药物2.1%，可卡因1.7%，苯丙胺0.7%，3,4 - 亚甲基二氧甲基苯丙胺（摇头丸）0.6%）。这些患者中只有57%声明使用过消遣性药物。使用消遣性药物的患者MAE发生率高于其他人（分别为13%和3%，p<0.001）。在对合并症进行调整后，消遣性药物与更高的院内MAE发生率相关（比值比8.84，95%置信区间4.68至16.7，p<0.001）。调整后，分别评估的大麻、可卡因和摇头丸与院内MAE独立相关。多种药物检测很常见（28%的阳性患者），且与更高的MAE发生率相关（比值比12.7，95%置信区间4.80至35.6，p<0.001）。
结论
入住ICCU的患者中消遣性药物使用的患病率为11%。消遣性药物检测与更差的院内结局独立相关。
临床试验注册
NCT05063097。
Zotero 插件