Invasive Approach and Revascularization Reduces Morbidity in Cocaine-Associated Non STEMI

It was a retrospective cohort study of 3,735 patients with NSTEMI and a history of cocaine use from the Nationwide Re-admissions Database from 2016 to 2017. The researchers determined the invasive approach as coronary angiography, percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG). They also determined the revascularization as PCI and CABG. The primary efficacy outcome was major adverse cardiac events (MACE), and the primary safety outcome was emergent revascularization. They used the appropriate International Classification of Diseases-Tenth Revision codes to identify non-adherence. They also used multivariate logistic regression to generate two propensity-matched cohorts (noninvasive vs invasive and noninvasive vs. revascularization).

Key findings of the study were:

• In the propensity score-matched cohorts, the researchers found that the invasive approach (hazard ratio [HR]: 0.72) and revascularization (HR: 0.54) were associated with a lower rate of MACE, without an increase in emergent revascularization when compared with a non-invasive approach.
• On stratification, they noted that PCI and CABG individually were associated with a lower rate of MACE.
• However, they noted that the emergent revascularization was increased with PCI (HR: 1.78) but not with CABG.
• They observed no significant difference in the rate of MACE among non-adherent patients after PCI and CABG, but, PCI in non-adherent patients was associated with an increase in emergent revascularization (HR: 4.45).

The authors concluded, "Invasive approaches and revascularization for cocaine-associated NSTEMI are associated with lower morbidity. A history of medical nonadherence was not associated with a difference in morbidity but was associated with an increased risk for emergent revascularization with PCI."

For further information:

https://www.jacc.org/doi/10.1016/j.jcin.2021.01.005