Cocaine-related aortic dissection: lessons from the International Registry of Acute Aortic Dissection.

Published

Journal Article

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 non cocaine 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 non cocaine-related dissection, likely due to the younger age at presentation.

Full Text

Duke Authors

Cited Authors

  • Dean, JH; Woznicki, EM; O'Gara, P; Montgomery, DG; Trimarchi, S; Myrmel, T; Pyeritz, RE; Harris, KM; Suzuki, T; Braverman, AC; Hughes, GC; Kline-Rogers, E; Nienaber, CA; Isselbacher, EM; Eagle, KA; Bossone, E

Published Date

  • September 2014

Published In

Volume / Issue

  • 127 / 9

Start / End Page

  • 878 - 885

PubMed ID

  • 24835037

Pubmed Central ID

  • 24835037

Electronic International Standard Serial Number (EISSN)

  • 1555-7162

Digital Object Identifier (DOI)

  • 10.1016/j.amjmed.2014.05.005

Language

  • eng

Conference Location

  • United States