# Prognostic Impact of Recreational Drug Use on 1-Year Outcomes in NSTEMI and STEMI Patients

## TL;DR

Recreational drug use increases the risk of heart-related complications in patients with heart attacks, especially those with STEMI.

## Contribution

This study identifies a significant link between recreational drug use and adverse outcomes in STEMI patients after one year.

## Key findings

- Recreational drug use was associated with a 2.7-fold higher risk of MACE in ACS patients.
- The association was stronger in STEMI patients (4.11-fold higher risk) compared to non-STEMI patients.
- Propensity matching confirmed the increased risk in STEMI patients.

## Abstract

Recreational drug use is increasingly associated with adverse outcomes in acute coronary syndrome (ACS) patients, but differences in long-term outcomes between ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction are not well defined.

The authors evaluated the association between recreational drug use and major adverse cardiovascular events (MACE) 1 year after intensive cardiac care unit (ICCU) admission in ACS patients.

The Addiction in Intensive Cardiac Care Units study systematically screened all patients admitted to ICCUs across 39 French centers (April 7-22, 2021) via prospective urinary testing. The primary outcome was MACE, defined as cardiovascular death, nonfatal myocardial infarction, or stroke. One-year follow-up was collected through clinical visits or direct contact between patients and cardiologists, concluding in June 2022. Outcomes were adjudicated by an independent cardiology committee. The prognostic impact of recreational drug use on MACE was assessed using multivariable Cox proportional hazards models, validated by propensity matching.

Of 712 ACS patients, 13.5% had recreational drug detection. At 1 year, MACE occurred in 7.0%, with higher rates among drug-positive vs drug-negative patients (12.5% vs 6.2%). Recreational drug use was associated with increased MACE (HR: 2.70; 95% CI: 1.30-5.57; P = 0.013). This association was significant in STEMI (HR: 4.11; 95% CI: 1.60-10.5; P = 0.005) but not in non-ST-elevation myocardial infarction patients. Propensity matching confirmed this in STEMI patients (HR: 3.39; 95% CI: 1.19-9.62; P = 0.022).

Recreational drug use was associated with increased 1-year MACE risk in ACS patients, particularly STEMI, supporting routine drug screening.