P3625Cocaine consumption and acute coronary syndrome: an analysis from the Swiss registry AMIS Plus

Introduction

The aim of this study is to evaluate the cardiovascular impact of cocaine in a population of patients enrolled in the Swiss nationwide AMIS Plus registry with a focus on in-hospital outcomes.

Methods

We retrospectively analysed data of patients enrolled in the Swiss AMIS Plus registry from 2007 to 2018. Baseline and in-hospital data of patients with ACS and cocaine use were compared with the remaining AMIS population as well as to a sex and aged matched ACS patients (1:5 ratio, 540 patients) without history of cocaine consumption. Primary endpoints were death and major adverse cardiac and cardiovascular events (MACCE).

Results

A total of 20'981 patients had been included in the AMIS Plus registry for ACS in the study period, of them 110 (0.5%) were cocaine user.

As compared to the remaining AMIS population, cocaine abusers were significantly younger (46.4±10.8 vs 66.4±13.2 years; p<0.001), presented more frequently with out of hospital cardiac arrest (11.8% vs 4.7%, p<0.001) and STEMI (68,2% vs 54.7%, p=0.007). Apart from active smoke and family history, had a lower burden of CV risk factors. In hospital mortality (3.6% vs 4.4%; p=1) and MACCE (5.4% vs 5.5%; p=0.83) were comparable.

When compared to the age matched ACS population without history of cocaine consumption, cocaine abusers were more frequently smokers (87.6% vs 63.6%, p<0.001) but less frequently obese (10.4% vs 25.6%, p=0,001). Clinical presentation was comparable among the two groups, nonetheless cocaine abuse was associated with a higher incidence of death (3.7% vs 0.7%, p<0.05) and MACCE (5.6% vs 1.3%, p<0.05).

Conclusion

This analysis presents the largest series of cocaine associated ACS available in literature. Cocaine abuse increases by 5 the risk of mortality and by 4 the risk of MACCE as compared to an age matched ACS population. No differences where observed in outcomes when compared to a 20 years older population.

Whipple endocarditis without overt gastrointestinal disease: report of four cases

BACKGROUND

Cardiac manifestations of Whipple disease are rarely diagnosed before death.

OBJECTIVE

To describe four patients with endocarditis caused by Tropheryma whippelii who did not have overt gastrointestinal disease.

DESIGN

Case series.

SETTING

Five hospitals in eastern Switzerland.

PATIENTS

Three men and one woman undergoing replacement of insufficient heart valves.

MEASUREMENTS

Histologic characteristics of heart valves and intestinal biopsy; broad-range and specific polymerase chain reaction for T. whippelii.

RESULTS

Tropheryma whippelii was found in the heart valves (three aortic valves and one mitral valve) of four patients with culture-negative endocarditis necessitating valve replacement. All patients had arthralgia for different lengths of time. Only one patient had mild gastrointestinal symptoms. Histologic characteristics of intestinal mucosa were normal in all patients, and polymerase chain reaction on intestinal biopsy was positive for T. whippelii in only one patient, who did not have diarrhea. In all patients, arthralgia resolved promptly after institution of antibiotic therapy. Disease did not recur in any patient after prolonged antibiotic therapy with cotrimoxazole.

CONCLUSION

In patients with culture-negative endocarditis, the absence of clinical, microscopic, or microbiological evidence of gastrointestinal disease did not rule out T. whippelii.

[ACE-inhibitors in acute heart infarct]

The use of ACE-inhibitors in heart failure has been established over the past years. Their use is of uncertain value in the early phases of myocardial infarction, where they are supposed to prevent left ventricular dilatation. More recent studies (ISIS-4, GISSI-3) have tested early treatment by ACE-inhibitors in the acute phase of myocardial infarction. On one hand, it was possible to disprove reservations about risks (hypotension)n in a large cohort; on the other hand, a further reduction of mortality in hospitalized patients by 7% has been shown, corresponding to five patient lives saved for 1000 treated patients. Thus, after institution of the customary therapy of myocardial infarction (inhibitor of platelet aggregation, thrombolysis, beta-blocker) and after exclusion of specific contraindications (hypotension < 100 mmHg, renal failure) ACE-inhibitors could be administered in the acute phase of myocardial infarction. An analysis of the results from these large trials will show whether ACE-inhibitors may benefit groups of patients at particular risks (Killip > 1, age > 70 years, preceding renal failure) noticeably. ACE-inhibitors remain the treatment of choice in patients with developing left ventricular failure.

[Early ergometry following acute myocardial infarction?]

One hundred and twenty patients underwent a symptom limited submaximal exercise test (SSET) 8-40 days after acute myocardial infarction. No complications occurred during the exercise test. Sixty-two patients (52%) showed a normal SSET. ST-segment depression (greater than or equal to 1 mm) was detected in 21 (17.5%). Dyspnea, fatigue, inadequate blood pressure response and angina pectoris without changes in ST-segments were the end-point in 33 patients (27.5%). Furthermore, significant premature ventricular contractions occurred in four cases (3%) and limited the SSET. An SSET soon after myocardial infarction can be performed without risk. High specificity of ST-segment depression in lead V5 was confirmed by the coronary angiographic findings. Apart from ST-segment depression there were other, more frequent nonspecific end-points of SSET which require further examination regarding their prognostic value.