Acute myocardial infarction in young age and drug dependence. Review of the literature and personal experience

• Published in: Giornale italiano di cardiologia Vol. 25; no. 10; p. 1273
• Main Authors: Massari, F M, Comerio, G, Perlini, S, Bocciolone, M, Lotto, A
• Format: Journal Article
• Language: Italian
• Published: Italy 01-10-1995
• Subjects: Adult; Cocaine; Female; Humans; Male; Myocardial Infarction - etiology; Myocardial Infarction - physiopathology; Risk Factors; Substance-Related Disorders - complications; Substance-Related Disorders - physiopathology
• ISSN: 0046-5968

The authors' personal experience in drug abuse-related acute myocardial infarction (AMI) is reported.
Between January 1991 and May 1994, 6 drug-addict (5 occasional) male patients (pts.) aged 37 +/-3 yrs (Group A) were admitted to our CCU for AMI. Just before hospital admission 4 pts. had inhaled cocaine and 1 had assumed ¿ecstasy¿ tablets; one patient had been heroine-dependent for 5 years and was in an attack of abstinence. The clinical features were compared to those of 17 not drug-addict pts. (Group B) aged <45 years (15 males). DEMOGRAPHIC DATA: In Group A 3/6 pts. were graduated (vs 29.4% in Group B pts.), and nobody belonged to the working class (vs 29.4%); 5/6 pts. (83.3%) were admitted during the week-end (vs 29.4%, p<0.03) and presented a longer time delay between symptoms' onset and hospital admission (7.1 +/- 6.9 hrs in Group A pts. vs 4.7 +/- 4.2 hrs. in Group B pts.).
All Group A pts. were smokers (37 +/- 12 cigarettes/day vs 21 +/- 14, p<0.02); 4/6 were heavy alcohol drinkers (vs 29.4%); 1/6 had a family history of ischemic heart disease (vs 35%); nobody was hypertensive(vs 29.4%) or diabetic (vs 5.8%). CLINICAL AND INSTRUMENTAL FINDINGS: On admission, Group A pts. (83.3%) were in Killip class I (vs 82.3%) infarct location was anterior in 3/6 pts. (vs 47%); all pts. were given thrombolitic agents. No significant coronary artery stenosis was found in 3/5 (60%) Group A pts. (vs 23.5% in Group B pts.), where 1 had one-vessel disease (vs 64%%) and 1 had two-vessel disease (vs 11.8%). Ejection fraction was similar in the two groups. No death was observed during follow-up (mean 14.4 +/- 9.6 months, range 3-39 months), 1 patient (Group A) had post AMI angina and reinfarction during coronary angioplasty and 2 pts. continued drug abuse.
AMI in drug addict subjects has to be taken into consideration in particular when the patient is young, male, alcohol consumer, heavy cigarette smoker, and is admitted during the week-end. Further study are warranted to better define therapeutic guidelines.