期刊
AMERICAN JOURNAL OF MEDICINE
卷 127, 期 9, 页码 878-885出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.amjmed.2014.05.005
关键词
Acute aortic dissection; Cocaine; Outcomes
资金
- WL Gore & Associates, Inc
- Medtronic, Inc
- Varbedian Aortic Research Fund
- Hewlett Foundation
- Mardigian Foundation
- UM Faculty Group Practice
- Terumo
- Robert and Anne Aikens
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 noncocaine 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 noncocaine-related dissection, likely due to the younger age at presentation. (C) 2014 Elsevier Inc. All rights reserved.
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