Cocaine use is associated with an increased risk of stent thrombosis after percutaneous coronary intervention

Background The treatment of cocaine-related acute coronary syndromes presents unique challenges. Although percutaneous coronary intervention in cocaine abusers appears to be safe in the short term, longer-term outcomes have not been reported. We postulated that cocaine use would be associated with increased risk for stent thrombosis. Methods We report 30-day and 9-month clinical outcomes including stent thrombosis, myocardial infarction, repeat revascularization, and death in 71 cocaine abusers who underwent percutaneous coronary intervention at our institution (66 of whom received a stent) compared with 3216 control patients. Propensity score-matched analysis was performed to control for statistical bias present in nonrandomized study populations. Results Stent thrombosis occurred in 5 (7.6%) of the 66 stented cocaine abusers during the 9-month follow-up period compared to a 0.6% rate of stent thrombosis in the control database, a highly statistically significant difference (P < .001). In the propensity analysis, stent thrombosis occurred in 4 stented cocaine abusers and 0 of 70 matched controls (6.2% vs 0%; P = .04) throughout the 9-month follow-up period. There was no significant difference in overall rates of myocardial infarction, death, or repeat revascularization at 9 months. Conclusions Because of the increased risk of stent thrombosis, consideration should be given to a more conservative approach in cocaine abusers who present with acute coronary syndromes.