Myocardial infarction and cannabis consumption: Two years of data collection in CHU Amiens-Picardie

Abstract

Cannabis is the most illicit drug consumed in France, with tetrahydrocannabinol (THC) levels increasing over past decades. The lack of epidemiological data concerning myocardial infarction (MI) occurring under cannabis use raises the question of imputability of THC as a cause of these serious cardiovascular events. In this context, it is essential to understand patient's characteristics in the North French region, where cardiovascular morbidity and mortality (20%) are greater than entire France (ARS, 2017). We performed a retrospective clinical study including patients in the Amiens University Hospital cardiac intensive care unit (CICU) for MI in a context of cannabis consumption between January 2020 and March 2022. Cannabis status was first determined using enzyme immunoassay method in urines (Atellica™ CH (Siemens®). Then blood quantifications of THC, 11-OH-THC and THC-COOH by LC-MS/MS (8060 Shimadzu®) was operated in case of positivity of urine samples. One-hundred-and-five patients were included. Median delay between hospitalisation and sample collection was 5 h 50. Twenty-nine patients (27.6%) were positive for cannabis urine testing. Their mean age was 34.5 years and 82.8% were men. Blood concentrations for THC, 11-OH-THC and THC-COOH were performed for 22 patients (with 7 uncollected blood samples). Eighteen were blood positive with respective mean (min; max) concentrations at 1.29 ng/mL (0.2; 3.7), 1.07 ng/mL (0.3; 6.7) and 21.7 ng/mL (1.3; 88.3), meaning patients were under cannabis influence during blood sampling. Similar results in literature showed that MI-cannabis induced risk population is mostly young men (Yang, Am J Med, 2020, 5:605–612). Knowing that chest pain occurs only few hours after smoking (Chetty, CJC Open, 2020, 1:12–21) and THC is rapidly relocated in organs (Goullé, Ann Pharm Fr, 2008, 4:232–244), it can be demonstrated that the patient's THC positivity is due to a short delay between smoking, chest pain and blood test. Ten blood samples were collected less than one hour after hospitalisation, revealed a well-known patients management of MI in young adult population by emergency and CICU services. Cannabis consumption declarative habits were collected for 14 patients: 7 patients smoked more than one joint per day (1 to 10) and the others smoked more than 1 joint per week. However, a very few data about cannabis kinetic were available, except time-lapse between chest pain and blood dosage for 9 patients, with a mean time of 16 hours (2h10; 48 h), with however a great variability. No patient was positive for others illicit drugs. Regarding clinical and biological data, mean body mass index was 26.41 kg/m2 and mean blood pressure was normal (121/81 mmHg). Nevertheless, cardiac biomarkers were impaired with troponin peak at 48,550 ng/L (3; 376890) and myoglobin at 723 μg/L (21; 7890). Tobacco use was the most frequently risk factor found in our patients: 93% were current smokers, as seen in others clinical studies (Aggarwal, JRSM Cardiovasc Dis, 2012, 1:8). However, it is difficult to determine whether tobacco or cannabis is the cause of MI due to the consumption mode (Chetty, CJC Open, 2020, 1:12–21). Other cardiovascular risk factors were identified: 7 obese patients, 5 high blood pressure patients and 4 diabetic patients. Left ventricular ejection fraction (LVEF) was preserved (LVEF > 50%) for 25 patients. Stent placement was the most common medical treatment. Unfortunately, one death has occurred. One of the limits of the study is the low number of patients. This study shows that characteristics of patients with MI induced by cannabis in North French region is similar to other global clinical studies. However, if cannabis use is lower than the total French average, risk factor prevention is essential in the French region with high cardiovascular morbidity.