Abstract 16915: Considerations in Management of Cocaine-Induced Coronary Disease and Embolism

Abstract

Background: Coronary embolism accounts for ~3% of cases of myocardial infarction (MI). We describe a case of a young patient with cocaine abuse with coronary thrombus resulting in acute coronary syndrome (ACS). Case: 33-year-old male with no known medical history seen in the ER with one hour of typical chest pain. EKG showed ST-segment elevations in inferior leads. Coronary angiogram demonstrated a hazy filling defect in the distal RCA as well as a 100% thrombotic occlusion of the right posterolateral branch of RCA likely due to distal embolization. Aspiration thrombectomy was performed with no residual stenosis. All other vessels were angiographically normal. Decision-Making: Our patient had no traditional coronary artery disease risk factors. Work-up for other coronary embolism causes and genetic thrombophilia was negative. We aspirated the thrombi rather than stenting, as stent thrombosis risk is >10-fold in cocaine users in absence of any residual stenosis. Dual antiplatelet therapy was initiated given ACS presentation. Conclusion: Acute coronary thrombosis is a life-threatening complication of cocaine abuse. In lack of residual stenosis post-aspiration thrombectomy, stenting can be avoided due to high stent thrombosis risk in this patient population.