Atherosclerotic plaque burden in cocaine users with acute chest pain: Analysis by coronary computed tomography angiography

Chest pain associated with cocaine use represents an increasing problem in the emergency department (ED). Cocaine use has been linked to the acute coronary syndrome (ACS) and acute myocardial infarction (AMI). We used coronary computed tomography angiography (cCTA) to evaluate the prevalence, severity and composition of atherosclerotic lesions in cocaine users. We studied 78 patients with non-occasional cocaine use (52 men, 44±7 years, 23 under the acute influence) and acute chest pain but without ACS, who had undergone cCTA in the ED. Patients were matched one-to-one by gender, race, symptoms, and risk-factors with a control cohort (n=78; 52 men, 45±6 years) not using cocaine. Each coronary segment was evaluated for the presence and composition (calcified, non-calcified, partially calcified) of atherosclerotic plaque and for stenosis. The prevalence of coronary stenosis was not significantly different between patients with and without cocaine use (13% versus 5%, P>0.05). However, cocaine users on average had significantly more atherosclerotic plaques (0.44±0.88 versus 0.29±0.83, P<0.05) and a tendency towards more calcified (0.64±1.23 versus 0.55±1.22, P>0.05) and non-calcified plaques (0.26±0.63 versus 0.17±0.57, P>0.05), yet not reaching statistical significance. Furthermore, cocaine users had significantly more partially calcified plaques (0.41±0.61 versus 0.17±0.41, P<0.05) and higher partially calcified plaque volume (59.7±33.3mm³ versus 25.6±12.6mm³, P<0.05). Thus, cocaine users tend to have more pronounced coronary atherosclerosis compared to patients without cocaine use at the time of presentation with acute chest pain.