Recreational Drug Use linked to Poor Outcomes After Acute Coronary Syndrome, suggests study

A new study published in the journal of JACC Advances revealed that recreational drug use detected at the time of admission for acute coronary syndrome (ACS) was associated with a higher risk of major adverse cardiovascular events during the following year. This association was significant only among patients who experienced ST-segment elevation myocardial infarction (STEMI), indicating a particularly vulnerable subgroup with worse long-term outcomes.

The findings come from the Addiction in Intensive Cardiac Care Units study, which systematically screened patients admitted to intensive cardiac care units (ICCUs) across 39 centers in France over a two-week period in April 2021. Unlike studies relying on self-reporting, this investigation used prospective urinary testing to detect recreational drug use, providing a more objective assessment.

A total of 712 patients admitted with ACS were included. Recreational drugs were detected in 13.5% of patients, highlighting that drug exposure is not uncommon in contemporary cardiac populations. The patients were followed for one year after their ICCU admission, with outcomes tracked through clinical visits or direct contact between cardiologists and patients, concluding in June 2022.

The primary outcome was major adverse cardiovascular events (MACE), a composite measure including cardiovascular death, nonfatal myocardial infarction, or stroke. Overall, 7.0% of patients experienced a MACE within one year. However, when broken down by drug exposure, a clear disparity emerged where 12.5% of patients with detected recreational drugs experienced MACE, when compared to 6.2% of those without drug detection.

Multivariable analysis showed that recreational drug use was independently associated with a significantly higher risk of MACE at one year, with nearly a threefold increase in risk after adjusting for clinical and demographic factors. This association was not uniform across all ACS subtypes. When patients were stratified by presentation, the elevated risk was driven almost entirely by those with STEMI.

Among STEMI patients, recreational drug use was associated with more than a 4-fold higher risk of MACE at one year. In contrast, no statistically significant association was observed in patients with NSTEMI. Even after this rigorous adjustment, recreational drug use remained strongly associated with worse outcomes in STEMI patients. Overall, this study suggest that recreational drug use is a powerful prognostic marker in ACS, particularly in STEMI, and argue that routine drug screening in ICCUs could help identify high-risk patients.

Source:

Aboujaoude, M., Hamache, N., Dillinger, J. G., Trimaille, A., Bouleti, C., Delmas, C., Schurtz, G., Houssany-Pissot, S., Vasram, R. R., Bonnet, G., Millischer, D., Thuaire, C., Roubille, F., Noirclerc, N., Andrieu, S., Fauvel, C., Mirailles, R., Hudelo, J., Gonçalves, T., … ADDICT-ICCU Investigators. (2026). Prognostic impact of recreational drug use on 1-year outcomes in NSTEMI and STEMI patients. JACC Advances, 5(2), 102574. https://doi.org/10.1016/j.jacadv.2025.102574