In-hospital outcomes following an acute coronary syndrome in patients with a recent cannabis use: Results from ADDICT-ICCU trial

Abstract

The prevalence and short-term cardiovascular consequences of recent cannabis use in patient admitted to the intensive cardiac care unit (ICCU) for acute coronary syndrome (ACS) is not well established. To assess the prevalence of recent cannabis use detected by a prospective systematic screening, and its prognostic value to predict the occurrence of in-hospital major adverse events (MAEs) in consecutive patients with ACS. In April 2021, all consecutive patients admitted to the ICCU in 39 centres throughout France were prospectively studied. Systematic illicit drug screening was performed on admission by urine assay in all patients. The primary outcome was the prevalence of recent cannabis use. The secondary outcome was in-hospital MAEs defined by death, resuscitated cardiac arrest and cardiogenic shock requiring medical or mechanical haemodynamic support. In the ADDICT-ICCU trial, 772 consecutive patients were hospitalized for ACS. After exclusion of patients with missing covariates, the final population for analysis was constituted of 743 patients (96.2%, (64 ± 13 years, 73% men) with 315 patients (42%) admitted for ST-elevation ACS and 428 (58%) patients for non-ST-elevation ACS. Among those, 83 patients (11.2%) had a positive urine test for cannabis (11.1% for STEMI and 11.1% for NSTEMI). Patients with an ACS and cannabis detected were more likely younger (53 years old for patients with cannabis detected vs. 65 in the other group, P < 0.001) and more frequently men (88% for patients with cannabis detected vs. 72%, P = 0.002). During hospitalisation, 33 (4.4%) in-hospital MAE occurred. The detection of cannabis was associated with a higher rate of in-hospital MAEs after adjustment for comorbidities (model 1: age, sex, smoking, cannabis drug test, diabetes, known coronary artery disease, creatinine, cannabis detected; adjusted odd [OR]: 3.29; 95% confidence interval [CI]: 1.21–8.41, P = 0.015), and after adjustment for known predictors of severity (model 2: age, sex, heart rate, systolic blood pressure, left ventricle ejection fraction, Killip classification, creatinine, cannabis detected; adjusted OR [OR]: 3.68; 95% CI: 1.33–9.57, P = 0.009) (Fig. 1). The prevalence of recent cannabis use in patients hospitalised in the ICCU for ACS was 11.2%. The detection of cannabis use was independently associated with a higher occurrence of in-hospital MAEs.