TY - JOUR
T1 - Cocaine-related aortic dissection
T2 - Lessons from the international registry of acute aortic dissection
AU - Dean, Joshua H.
AU - Woznicki, Elise M.
AU - O'Gara, Patrick
AU - Montgomery, Daniel G.
AU - Trimarchi, Santi
AU - Myrmel, Truls
AU - Pyeritz, Reed E.
AU - Harris, Kevin M.
AU - Suzuki, Toru
AU - Braverman, Alan C.
AU - Hughes, G. Chad
AU - Kline-Rogers, Eva
AU - Nienaber, Christoph A.
AU - Isselbacher, Eric M.
AU - Eagle, Kim A.
AU - Bossone, Eduardo
N1 - Funding Information:
Funding: The International Registry of Acute Aortic Dissection receives funding from WL Gore & Associates, Inc , Medtronic, Inc , Varbedian Aortic Research Fund , the Hewlett Foundation , the Mardigian Foundation , UM Faculty Group Practice , Terumo , and Robert and Anne Aikens .
Funding Information:
Conflict of Interest: Dr Eagle receives unrestricted grant and research support from Medtronic, Inc, and WL Gore & Associates, Inc; receives grant and research support from the Hewlett Foundation; and is a consultant to the National Institutes of Health and National Heart, Lung, and Blood Institute.
Publisher Copyright:
© 2014 Elsevier Inc.
PY - 2014/9/1
Y1 - 2014/9/1
N2 - Background Acute aortic dissection associated with cocaine use is rare and has been reported predominantly as single cases or in small patient cohorts.Methods Our study analyzed 3584 patients enrolled in the International Registry of Acute Aortic Dissection from 1996 to 2012. We divided the population on the basis of documented cocaine use (C+) versus noncocaine use (C-) and further stratified the cohorts into type A (33 C+/2332, 1.4%) and type B (30 C+/1252, 2.4%) dissection.Results C+ patients presented at a younger age and were more likely to be male and black. Type B dissections were more common among C+ patients than in C- patients. Cocaine-related acute aortic dissection was reported more often at US sites than at European sites (86.4%, 51/63 vs 13.6%, 8/63; P <.001). Tobacco use was more prevalent in the C+ cohort. No differences were seen in history of hypertension, known atherosclerosis, or time from symptom onset to presentation. Type B C+ patients were more likely to be hypertensive at presentation. C+ patients had significantly smaller ascending aortic diameters at presentation. Acute renal failure was more common in type A C+ patients; however, mortality was significantly lower in type A C+ patients.Conclusions Cocaine use is implicated in 1.8% of patients with acute aortic dissection. The typical patient is relatively young and has the additional risk factors of hypertension and tobacco use. In-hospital mortality for those with cocaine-related type A dissection is lower than for those with noncocaine-related dissection, likely due to the younger age at presentation.
AB - Background Acute aortic dissection associated with cocaine use is rare and has been reported predominantly as single cases or in small patient cohorts.Methods Our study analyzed 3584 patients enrolled in the International Registry of Acute Aortic Dissection from 1996 to 2012. We divided the population on the basis of documented cocaine use (C+) versus noncocaine use (C-) and further stratified the cohorts into type A (33 C+/2332, 1.4%) and type B (30 C+/1252, 2.4%) dissection.Results C+ patients presented at a younger age and were more likely to be male and black. Type B dissections were more common among C+ patients than in C- patients. Cocaine-related acute aortic dissection was reported more often at US sites than at European sites (86.4%, 51/63 vs 13.6%, 8/63; P <.001). Tobacco use was more prevalent in the C+ cohort. No differences were seen in history of hypertension, known atherosclerosis, or time from symptom onset to presentation. Type B C+ patients were more likely to be hypertensive at presentation. C+ patients had significantly smaller ascending aortic diameters at presentation. Acute renal failure was more common in type A C+ patients; however, mortality was significantly lower in type A C+ patients.Conclusions Cocaine use is implicated in 1.8% of patients with acute aortic dissection. The typical patient is relatively young and has the additional risk factors of hypertension and tobacco use. In-hospital mortality for those with cocaine-related type A dissection is lower than for those with noncocaine-related dissection, likely due to the younger age at presentation.
KW - Acute aortic dissection
KW - Cocaine
KW - Outcomes
UR - http://www.scopus.com/inward/record.url?scp=84908216944&partnerID=8YFLogxK
U2 - 10.1016/j.amjmed.2014.05.005
DO - 10.1016/j.amjmed.2014.05.005
M3 - Article
C2 - 24835037
AN - SCOPUS:84908216944
SN - 0002-9343
VL - 127
SP - 878
EP - 885
JO - American Journal of Medicine
JF - American Journal of Medicine
IS - 9
ER -