Reasonability of urine toxicology screening for methamphetamine and cocaine in young acute myocardial infarction

Abstract

Aim: Prior cocaine and methamphetamine use influence treatment strategies in subjects with acute myocardial infarction. Often patients may not self-report illicit drug use on admission but urine analysis may reveal etiology. This study aimed to investigate if routine screening of cocaine and methamphetamine use by urine analysis is reasonable in young myocardial infarction.Material and Methods: This study enrolled 50 consecutive young patients (≤50 years old) with acute myocardial infarction. Mean age was 41.3±7.8 (21-50) and 80% of patients were male. Patients were queried about the use of any illicit drug use on admission. Urine samples for cocaine and methamphetamine analysis were done using immunuassay tests within the first day of admission. Cocaine use was considered as positive if the level of benzoylecgonine was above 300 ng/mL. Methamphetamine use was considered as positive if the level was above 1000 ng/mL. All the patients underwent coronary angiography and percutaneous coronary revascularization if they had significant coronary artery stenosis.Results: ST elevated acute myocardial infarction was diagnosed in 38 patients (76%) and non-ST elevated acute myocardial infarction was diagnosed in 12 patients (24%). No patient self-reported cocaine or methamphetamine use. Urine analyses for cocaine were negative in all 50 patients. In urine analyses methamphetamine were found to be positive in 5 patients (10%). Classical risk factors for atherosclerosis were similar between the groups.Conclusion: As we found 10% incidence of methamphetamine use, it may be reasonable to screen methamphetamine use but not cocaine use by urine analysis in younger myocardial infarction patients