Physicians' Academy for Cardiovascular Education

Cocaine disturbs coronary blood flow

Nov. 24, 2014 - news

 

Cocaine users experience abnormal blood flow, risk heart disease

 
Presented at the AHA Scientific Sessions 2014 by: Varun Kumar (Cardiovascular Division, Department of Medicine, Mount Sinai Hospital Medical Center, Chicago, IL)
 

Background

Cocaine users who report chest pain may have disturbed blood flow in the coronary microvasculature. This may not be picked up with regular tests, and these patients may risk cardiac complications or even death. The presence of coronary microvascular dysfunction is, despite normal epicardial coronary arteries, a common factor that can affect mortality and morbidity.
Considering the increasing number of people who use cocaine in urban populations, it is necessary to study the effect of cocaine on the coronary microvasculature. Heart films of 202 cocaine users were compared with those of randomly picked non-users. Microvascular dysfunction was determined by means of corrected TIMI frame count (cTFC) and TIMI perfusion grade (TMPG) in people without acute or recent myocardial infarction (MI), significant epicardial coronary artery disease (CAD) or vasospasms. Angiograms were assessed blindly.
 

Main results

  • The TMPG 0/1 for the left anterior descending (LAD), circumflex (LCx) and right coronary (RCA) artery were statistically significant among cocaine users (LAD: 22% vs. 5%, P<0.0001, LCx: 25% vs. 6%, P<0.0001, RCA: 42% vs. 8%, P<0.0001).
  • For cTFC, LAD and LCx were significantly increased in cocaine users (27.33 + 10.9 vs. i24.88 + 10.05, P=0.03 and 41.11 + 14.28 vs. 38.23 + 12.69, P=0.04).
  • A significant percentage of cocaine users had cTFC<14 (thus faster blood flow) in the RCA (9% vs. 3%, P=0.008).
 

Conclusion

This study shows that cocaine use is associated with significant coronary microvascular dysfunction, despite the absence of significant epicardial CAD. A lower coronary filling time could be the reason for the observed higher frequency of hyperaemic flow in RCA, which was associated with worse clinical outcomes, mostly in the context of disturbed myocardial perfusion.