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Genç akut miyokard infarktüslerinde metamfetamin ve kokain için idrar toksikoloji taramasının uygulanabilirliği

Year 2020, , 72 - 76, 21.03.2020
https://doi.org/10.18663/tjcl.624686

Abstract

Amaç: Öyküsünde kokain ve metamfetamin kullanımı olan, akut miyokart enfarktüsü geçiren hastalarda tedavi stratejisi değişmektedir. Hastalar genellikle hastaneye kabulde yasa dışı uyuşturucu kullanımını kendi kendine bildirmeyebilirler ancak idrar analizi etyolojiyi ortaya çıkarabilir. Bu çalışma, genç yaşta akut miyokart enfarktüsü geçirenlerde kokain ve metamfetamin kullanımının idrar analizi ile rutin olarak taranmasının makul olup olmadığını araştırmayı amaçlamaktadır.

Gereç ve Yöntemler: Çalışmaya akut miyokart enfarktüsü geçiren ardışık 50 genç hasta (≤50 yaşında) alındı. Hastaların yaş ortalaması 41.3 ± 7.8 (21-50) di ve hastaların% 80'i erkekti. Hastalar hastaneye kabul sırasında herhangi bir yasa dışı uyuşturucu kullanımının olup olmadığı hakkında sorgulandı. Kokain ve metamfetamin analizi için idrar örnekleri, yatışın ilk günü içinde immünolojik testler kullanılarak yapıldı. Benzoylecgonine seviyesi 300 ng / mL'nin üzerindeyse kokain kullanımı pozitif olarak kabul edildi. Eğer seviye 1000 ng / mL'nin üzerindeyse, metamfetamin kullanımı pozitif olarak kabul edildi. Tüm hastalara koroner anjiografi yapıldı ve ciddi koroner lezyonu olanlara perkütan koroner revaskülarizasyon uygulandı.

Bulgular: 38 hastada (%76) ST yükselmeli akut miyokart enfarktüsü, 12 hastada (% 24) ST yükselmesiz akut miyokart enfarktüsü saptandı. Hiçbir hasta kendiliğinden kokanin ve metamfetamine kullandığını belirtmedi. 50 hastanın hiçbirinde idrar analizinde kokain saptanmadı. 5 hastada (%10) idrar metamfetamine düzeyi pozitif saptandı. Ateroskleroz için klasik risk faktörleri gruplar arasında benzerdi.

Sonuç: Metamfetamin kullanımını %10 bulduğumuz için, daha genç miyokart infarktüsü geçiren hastalarda idrar analiziyle metamfetamin kullanımının taranması makul olabilir.

References

  • 1. Flores ED, Lange RA, Cigarroa RG, et al. Effect of cocaine on coronary artery dimensions in atherosclerotic coronary artery disease: enhanced vasoconstriction at sites of significant stenoses. J Am Coll Cardiol 1990; 16: 74–79
  • 2. Stenberg RG, Winniford MD, Hillis LD, et al. Simultaneous acute thrombosis of two major coronary arteries following intravenous cocaine use. Arch Pathol Lab Med 1989; 113: 521–524
  • 3. McCord J1, Jneid H, Hollander JE, et al. American Heart Association Acute Cardiac Care Committee of the Council on Clinical Cardiology. Management of cocaine-associated chest pain and myocardial infarction: a scientific statement from the American Heart Association Acute Cardiac Care Committee of the Council on Clinical Cardiology. Circulation 2008; 117: 1897-907
  • 4. Amsterdam EA, Wenger NK, Brindis RG et al. American College of Cardiology; American Heart Association Task Force on Practice Guidelines; Society for Cardiovascular Angiography and Interventions; Society of Thoracic Surgeons; American Association for Clinical Chemistry. 2014 AHA/ACC Guideline for the Management of Patients with Non-ST-Elevation Acute Coronary Syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014; 64: 139-228
  • 5. Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD; Writing Group on behalf of the Joint ESC/ACCF/AHA/ WHF Task Force for the Universal Definition of Myocardial Infarction. Glob Heart 2012; 7: 275-95
  • 6. Hamm CW, Bassand JP, Agewall S et al. ESC Committee for Practice Guidelines. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2011; 32: 2999-3054
  • 7. Lange RA, Hillis LD. Cardiovascular complications of cocaine use. N Engl J Med 2001; 345: 351–358
  • 8. Baumann BM, Perrone J, Hornig SE, Shofer FS, Hollander JE. Randomized, double-blind, placebo-controlled trial of diazepam, nitroglycerin, or both for treatment of patients with potential cocaine-associated acute coronary syndromes. Acad Emerg Med 2000; 7: 878–85.
  • 9. Albertson TE, Dawson A, de Latorre F, Hoffman RS, Hollander JE, Jaeger A, Kerns WR 2nd, Martin TG, Ross MP; American Heart Association; International Liaison Committee on Resuscitation. TOX-ACLS: toxicologic-oriented advanced cardiac life support. Ann Emerg Med 2001; 37: 78 –S90.
  • 10. Bush HS. Cocaine-associated myocardial infarction: a word of caution about thrombolytic therapy. Chest 1988; 94: 878.
  • 11. Hollander JE, Wilson LD, Leo PJ, Shih RD. Complications from the use of thrombolytic agents in patients with cocaine associated chest pain. J Emerg Med 1996; 14: 731–36
  • 12. LoVecchio F, Nelson L. Intraventricular bleeding after the use of thrombolytics in a cocaine user. Am J Emerg Med 1996; 14: 663– 64
  • 13. Crits-Christoph P, Siqueland L, Blaine J et al. Psychosocial treatments for cocaine dependence: National Institute on Drug Abuse Collaborative Cocaine Treatment Study. Arch Gen Psychiatry 1999; 56: 493–502
  • 14. European drug report; Trends and developments 2015.p. 40 European Monitoring Centre for Drugs and Drug Addiction, Luxembourg: Publications Office of the European Union, 2015
  • 15. EMCDDA TURKISH DRUG REPORT 2014 (2013 data) : Reitox National Focal Point Turkey: New Development, Trends and in-depth information on selected issues. Ankara: Turkish Monitoring Centre for Drugs and Drug Addiction.p.37 KOM Publications 2014
  • 16. Canga Y, Osmonov D, Karataş MB, Durmuş G, Ilhan E, Kırbaş V. Cannabis: a rare trigger of premature myocardial infarction. Anatolian J Cardiol 2011; 11: 272-74
  • 17. Karabulut, A., Cakmak, M. ST segment elevation myocardial infarction due to slow coronary flow occurring after cannabis consumption. Kardiol Pol. 2010;68:1266–68
  • 18. Tatlı E, Yılmaztepe M, Altun G, Altun A. Cannabis-induced coronary artery thrombosis and acute anterior myocardial infarction in a young man. Int J Cardiol 2007; 120: 420-2
  • 19. Kocabay G, Yıldız M, Duran NE, Özkan M. Acute inferior myocardial infarction due to cannabis smoking in a young man. J Cardiovascular Med 2009; 10: 669-70
  • 20. Ayhan H, Aslan AN, Süygün H, Durmaz T. Bonsai induced acute myocardial infarction. Arch Turk Soc Cardiol 2014; 42: 560-63
  • 21. Köklü E, Yüksel İÖ, Bayar N, Üreyen ÇM, Arslan Ş. A new cause of silent myocardial infarction: Bonsai. Anatolian J Cardiol 2015; 15: 69-74
  • 22. Velibey Y, Sahin S, Tanık O, Keskin M, Bolca O, Eren M. Acute myocardial infarction due to marijuana smoking in a young man: guilty should not be underestimated. Am J Emerg Med 2015 ;33: 1114.e1-3
  • 23. Moliterno DJ, Willard JE, Lange RA, Negus BH, Boehrer JD, Glamann DB, Landau C, Rossen JD, Winniford MD, Hillis LD. Coronary-artery vasoconstriction induced by cocaine, cigarette smoking, or both. N Engl J Med 1994; 330: 454–59.
  • 24. Hollander JE, Hoffman RS, Gennis P, Fairweather P, Feldman JA, Fish SS, DiSano MJ, Schumb DA, Dyer S. Cocaine-associated chest pain: one-year follow-up. Acad Emerg Med 1995; 2: 179–84

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

Year 2020, , 72 - 76, 21.03.2020
https://doi.org/10.18663/tjcl.624686

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

References

  • 1. Flores ED, Lange RA, Cigarroa RG, et al. Effect of cocaine on coronary artery dimensions in atherosclerotic coronary artery disease: enhanced vasoconstriction at sites of significant stenoses. J Am Coll Cardiol 1990; 16: 74–79
  • 2. Stenberg RG, Winniford MD, Hillis LD, et al. Simultaneous acute thrombosis of two major coronary arteries following intravenous cocaine use. Arch Pathol Lab Med 1989; 113: 521–524
  • 3. McCord J1, Jneid H, Hollander JE, et al. American Heart Association Acute Cardiac Care Committee of the Council on Clinical Cardiology. Management of cocaine-associated chest pain and myocardial infarction: a scientific statement from the American Heart Association Acute Cardiac Care Committee of the Council on Clinical Cardiology. Circulation 2008; 117: 1897-907
  • 4. Amsterdam EA, Wenger NK, Brindis RG et al. American College of Cardiology; American Heart Association Task Force on Practice Guidelines; Society for Cardiovascular Angiography and Interventions; Society of Thoracic Surgeons; American Association for Clinical Chemistry. 2014 AHA/ACC Guideline for the Management of Patients with Non-ST-Elevation Acute Coronary Syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014; 64: 139-228
  • 5. Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD; Writing Group on behalf of the Joint ESC/ACCF/AHA/ WHF Task Force for the Universal Definition of Myocardial Infarction. Glob Heart 2012; 7: 275-95
  • 6. Hamm CW, Bassand JP, Agewall S et al. ESC Committee for Practice Guidelines. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2011; 32: 2999-3054
  • 7. Lange RA, Hillis LD. Cardiovascular complications of cocaine use. N Engl J Med 2001; 345: 351–358
  • 8. Baumann BM, Perrone J, Hornig SE, Shofer FS, Hollander JE. Randomized, double-blind, placebo-controlled trial of diazepam, nitroglycerin, or both for treatment of patients with potential cocaine-associated acute coronary syndromes. Acad Emerg Med 2000; 7: 878–85.
  • 9. Albertson TE, Dawson A, de Latorre F, Hoffman RS, Hollander JE, Jaeger A, Kerns WR 2nd, Martin TG, Ross MP; American Heart Association; International Liaison Committee on Resuscitation. TOX-ACLS: toxicologic-oriented advanced cardiac life support. Ann Emerg Med 2001; 37: 78 –S90.
  • 10. Bush HS. Cocaine-associated myocardial infarction: a word of caution about thrombolytic therapy. Chest 1988; 94: 878.
  • 11. Hollander JE, Wilson LD, Leo PJ, Shih RD. Complications from the use of thrombolytic agents in patients with cocaine associated chest pain. J Emerg Med 1996; 14: 731–36
  • 12. LoVecchio F, Nelson L. Intraventricular bleeding after the use of thrombolytics in a cocaine user. Am J Emerg Med 1996; 14: 663– 64
  • 13. Crits-Christoph P, Siqueland L, Blaine J et al. Psychosocial treatments for cocaine dependence: National Institute on Drug Abuse Collaborative Cocaine Treatment Study. Arch Gen Psychiatry 1999; 56: 493–502
  • 14. European drug report; Trends and developments 2015.p. 40 European Monitoring Centre for Drugs and Drug Addiction, Luxembourg: Publications Office of the European Union, 2015
  • 15. EMCDDA TURKISH DRUG REPORT 2014 (2013 data) : Reitox National Focal Point Turkey: New Development, Trends and in-depth information on selected issues. Ankara: Turkish Monitoring Centre for Drugs and Drug Addiction.p.37 KOM Publications 2014
  • 16. Canga Y, Osmonov D, Karataş MB, Durmuş G, Ilhan E, Kırbaş V. Cannabis: a rare trigger of premature myocardial infarction. Anatolian J Cardiol 2011; 11: 272-74
  • 17. Karabulut, A., Cakmak, M. ST segment elevation myocardial infarction due to slow coronary flow occurring after cannabis consumption. Kardiol Pol. 2010;68:1266–68
  • 18. Tatlı E, Yılmaztepe M, Altun G, Altun A. Cannabis-induced coronary artery thrombosis and acute anterior myocardial infarction in a young man. Int J Cardiol 2007; 120: 420-2
  • 19. Kocabay G, Yıldız M, Duran NE, Özkan M. Acute inferior myocardial infarction due to cannabis smoking in a young man. J Cardiovascular Med 2009; 10: 669-70
  • 20. Ayhan H, Aslan AN, Süygün H, Durmaz T. Bonsai induced acute myocardial infarction. Arch Turk Soc Cardiol 2014; 42: 560-63
  • 21. Köklü E, Yüksel İÖ, Bayar N, Üreyen ÇM, Arslan Ş. A new cause of silent myocardial infarction: Bonsai. Anatolian J Cardiol 2015; 15: 69-74
  • 22. Velibey Y, Sahin S, Tanık O, Keskin M, Bolca O, Eren M. Acute myocardial infarction due to marijuana smoking in a young man: guilty should not be underestimated. Am J Emerg Med 2015 ;33: 1114.e1-3
  • 23. Moliterno DJ, Willard JE, Lange RA, Negus BH, Boehrer JD, Glamann DB, Landau C, Rossen JD, Winniford MD, Hillis LD. Coronary-artery vasoconstriction induced by cocaine, cigarette smoking, or both. N Engl J Med 1994; 330: 454–59.
  • 24. Hollander JE, Hoffman RS, Gennis P, Fairweather P, Feldman JA, Fish SS, DiSano MJ, Schumb DA, Dyer S. Cocaine-associated chest pain: one-year follow-up. Acad Emerg Med 1995; 2: 179–84
There are 24 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Orıgınal Artıcle
Authors

Ender Örnek

Alparslan Kurtul

Murat Gök

Publication Date March 21, 2020
Published in Issue Year 2020

Cite

APA Örnek, E., Kurtul, A., & Gök, M. (2020). Reasonability of urine toxicology screening for methamphetamine and cocaine in young acute myocardial infarction. Turkish Journal of Clinics and Laboratory, 11(2), 72-76. https://doi.org/10.18663/tjcl.624686
AMA Örnek E, Kurtul A, Gök M. Reasonability of urine toxicology screening for methamphetamine and cocaine in young acute myocardial infarction. TJCL. March 2020;11(2):72-76. doi:10.18663/tjcl.624686
Chicago Örnek, Ender, Alparslan Kurtul, and Murat Gök. “Reasonability of Urine Toxicology Screening for Methamphetamine and Cocaine in Young Acute Myocardial Infarction”. Turkish Journal of Clinics and Laboratory 11, no. 2 (March 2020): 72-76. https://doi.org/10.18663/tjcl.624686.
EndNote Örnek E, Kurtul A, Gök M (March 1, 2020) Reasonability of urine toxicology screening for methamphetamine and cocaine in young acute myocardial infarction. Turkish Journal of Clinics and Laboratory 11 2 72–76.
IEEE E. Örnek, A. Kurtul, and M. Gök, “Reasonability of urine toxicology screening for methamphetamine and cocaine in young acute myocardial infarction”, TJCL, vol. 11, no. 2, pp. 72–76, 2020, doi: 10.18663/tjcl.624686.
ISNAD Örnek, Ender et al. “Reasonability of Urine Toxicology Screening for Methamphetamine and Cocaine in Young Acute Myocardial Infarction”. Turkish Journal of Clinics and Laboratory 11/2 (March 2020), 72-76. https://doi.org/10.18663/tjcl.624686.
JAMA Örnek E, Kurtul A, Gök M. Reasonability of urine toxicology screening for methamphetamine and cocaine in young acute myocardial infarction. TJCL. 2020;11:72–76.
MLA Örnek, Ender et al. “Reasonability of Urine Toxicology Screening for Methamphetamine and Cocaine in Young Acute Myocardial Infarction”. Turkish Journal of Clinics and Laboratory, vol. 11, no. 2, 2020, pp. 72-76, doi:10.18663/tjcl.624686.
Vancouver Örnek E, Kurtul A, Gök M. Reasonability of urine toxicology screening for methamphetamine and cocaine in young acute myocardial infarction. TJCL. 2020;11(2):72-6.


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