Percutaneous interventions in patients with cocaine‐associated myocardial infarction: A case series and review

Abstract

Cocaine-associated myocardial infarction (CAMI) is a well-reported entity. Most previous reports on CAMI have been limited to conservative care utilizing benzodiazepines, aspirin, nitroglycerin, calcium channel blockers, and thrombolytics. Current guidelines on CAMI advocate immediate use of angiography and angioplasty if available rather than routine administration of thrombolytics. However, based on literature search from 1966 to 2001 (using keywords "cocaine," "myocardial infarction," and "angioplasty"), there have been only two case reports of percutaneous coronary intervention (PCI) in patients with cocaine-associated myocardial infarction. Both were notable for complications either during or immediately after the procedure. We report a series of 10 patients with cocaine-associated myocardial infarction who were treated with percutaneous interventions, which included angioplasty, stenting, and AngioJet mechanical extraction of thrombus. Despite the different arteriopathic process involved, our findings suggest that PCI can be performed safely and with a high degree of procedural success in patients with CAMI.

Management of Cocaine-Associated Chest Pain and Myocardial Infarction

“…[71][72][73] Fibrinolytic therapy should be reserved for patients who are clearly having an ST-segmentelevation MI who cannot receive direct percutaneous coronary intervention. 63,64,66,68,70 No data are available regarding the use of drug-eluting stents in patients who abuse cocaine, but they would be expected to decrease in-stent restenosis as compared with bare metal stents as in patients who do not use cocaine. Moreover, few data are available regarding drug-eluting stent use in ST-elevation MI patients who have not ingested cocaine.…”

The cardiovascular effects of cocaine

“…Several factors mitigate the use of thrombolytics in the management of CAMI, including: the low overall mortality of patients with CAMI, the difficulty in making a reliable diagnosis, as well as a higher risk of treatment complications in this population (i.e., increased risk for cerebrovascular hemorrhage) (13,34,74,75). Some authors in this setting have advocated the use of coronary artery angioplasty, but like thrombolytic agents, its efficacy has never been proven (76). To date, the use of glycoprotein IIb/IIIa inhibitors in the setting of CAMI has not been investigated.…”

[No Title Available]

“…The early development of coronary atherosclerosis in chronic cocaine abusers has been reported in the literature (7,8) . In the present case, a soft plaque with mild stenosis was detected in the proximal left anterior descending coronary artery.…”

“…Usually, the treatment is clinical, with benzodiazepines, aspirin, nitroglycerin, verapamil, besides stimulus for behavioral change . However, some authors such as Sharma et al (7) believe that a percutaneous coronary intervention at the moment of the vasospasm is the treatment of choice for such patients.…”