P2514Cocaine-related sudden cardiac arrest in the general population

Abstract

Background: Cocaine use in the general population has increased in recent years and although cardiovascular effects of cocaine have been investigated, cocaine-related sudden cardiac arrest (SCA) in the overall community has been scarcely described, with available information mostly derived from forensic studies. Purpose: We sought to describe the characteristics and outcomes of cocainerelated SCA compared to other SCA in the general population. Methods: In this prospective ongoing multicentre population-based registry (6.6 million inhabitants), all SCA over a 5-year period were prospectively enrolled. Data from all SCA, alive at hospital admission, were analyzed with a specific focus on cases occurring after acute cocaine use. Acute cocaine use was defined as witnessed use just prior to the cardiac arrest event, or positive toxicology for cocaine. Results: Among the 3,028 SCAs admitted alive out of a total of 18,622 out-ofhospital cardiac arrests from May 2011 to May 2016, 32 SCAs (1.1%) were eventually associated with cocaine use. 18 were recent users and 26 were chronic active users. Compared to SCA from other cause, cocaine-related SCA victims were younger (44.1 vs. 59.3 years, P<0.001), with greater proportion of males (87.5 vs. 73.0%, P=0.058), lesser known coronary artery disease (CAD) (0 vs. 18.4%, P<0.001), but significantly more frequent active smoking (65.6 vs. 30.2%, P<0.001). Noteworthy, cocaine-related SCA more often had positive family history of SCA (10.0 vs. 2.4%, P=0.038). The main causes of cocaine-associated SCA were acute myocardial ischemia (13/28 cases, 48.1%), including coronary spasm in 8 cases (61.5%), followed by multiple drug intoxication (18.5%), hypoxic causes (11.1%), pulmonary embolism (7.4%) and miscellaneous. There was no significant difference regarding etiologies between recent cocaine and active chronic users. SCA characteristics, initial management, investigations, imaging strategy, survival rate (28.1% vs 26.8%; P=0.84) and ICD implantation at hospital discharge were not significantly different in cocaine-associated versus all SCA. Conclusions: Cocaine is a rare SCA trigger (1.1% of all SCA), mostly occurring in young, actively smoking men. Coronary spasm without underlying CAD is the leading cause. Despite occurrence in a younger age group, survival is similar to overall SCA, highlighting a poorer prognosis for this form of SCA and the need to raise public awareness of this uncommon but devastating manifestation of cocaine use.