Acute Coronary Syndrome and Khat Herbal Amphetamine Use

Abstract

Background— The khat plant is a stimulant similar to amphetamine and is thought to induce coronary artery spasm. Khat is widely chewed by individuals originating from the Horn of Africa and the Arabian Peninsula. The aim of this study was to evaluate the clinical characteristics and outcome of khat chewers presenting with acute coronary syndrome. Methods and Results— From October 1, 2008, through June, 30, 2009, 7399 consecutive patients with acute coronary syndrome were enrolled in the Second Gulf Registry of Acute Coronary Events (Gulf RACE-2). Nineteen percent of patients were khat chewers; 81% were not. Khat chewers were older, more often male, and less likely to have cardiovascular risk factors. Khat chewers were less likely to have a history of coronary artery disease and more likely to present late and to have higher heart rate and advanced Killip class on admission. Khat chewers were more likely to present with ST-segment–elevation myocardial infarction. Overall, khat chewers had higher risk of death, recurrent myocardial ischemia, cardiogenic shock, ventricular arrhythmia, and stroke compared with non–khat chewers. After adjustment for baseline variability, khat chewing was found to be an independent risk factor of death and for recurrent ischemia, heart failure, and stroke. Conclusions— Our data confirm earlier observations of worse in-hospital outcome among acute coronary syndrome patients who chew khat. This worse outcome persists up to 1 year from the index event. This observational report underscores the importance of improving education concerning the cardiovascular risks of khat chewing.

Drugs That May Cause or Exacerbate Heart Failure

“…The stimulant sympathomimetics can increase blood pressure by a few millimeters of mercury, but more concerning are reports of sudden death, acute coronary syndrome, MI, stroke, and cardiomyopathy associated with their use. [187][188][189][190][191][192][193][194][195][196] Despite these case reports and small series documenting cardiac toxicity associated with stimulants, large epidemiological studies performed in children and adults treated with stimulants found no increase in the risk of serious cardiovascular events (stroke, MI, and sudden death). 197,198 Considering the case reports and well-recognized risk of sympathetic stimulation in patients with serious cardiac disease, sympathomimetic stimulants are not generally used in patients with HF.…”

β‐Blocker Therapy Prior to Admission for Acute Coronary Syndrome in Patients Without Heart Failure or Left Ventricular Dysfunction Improves In‐Hospital and 12‐Month Outcome: Results From the GULF‐RACE 2 (Gulf Registry of Acute Coronary Events‐2)

“…Details of patients' recruitment, study design, and methods have been previously published 7, 8. Briefly, we collected data, as per the case report form, of consecutive patients hospitalized for ACS in the 65 participating hospitals across the participating countries.…”

La toxicité du khat impose-t-elle une modification de la réglementation de son usage en Europe?

“…Cependant, l'origine principalement yéménite des patients souffrant de cardiopathie pourrait constituer un biais notamment par un recours retardé aux soins hospitaliers [53]. Une nouvelle cohorte de recrutement proche confirme le mauvais pronostic associé à l'usage de khat en cas d'infarctus [54]. Ceci peut s'expliquer par le délai entre douleur initiale et hospitalisation, plus long que chez les non consommateurs.…”

“…Mais si 75 % des consommateurs de khat résident au Yémen où l'efficacité du réseau médical est moins performante, le délai pourrait aussi s'expliquer par l'effet analgésique du khat [55,56]. Par ailleurs, l'efficacité de la thrombolyse semble réduite par l'effet pro thrombotique de la cathinone [54,57,58].…”