• Joshua H Dean, Elise M Woznicki, Patrick O'Gara, Daniel G Montgomery, Santi Trimarchi, Truls Myrmel, Reed E Pyeritz, Kevin M Harris, Toru Suzuki, Alan C Braverman, G Chad Hughes, Eva Kline-Rogers, Christoph A Nienaber, Eric M Isselbacher, Kim A Eagle, and Eduardo Bossone.
• Cardiovascular Center, University of Michigan, Ann Arbor.
• Am. J. Med. 2014 Sep 1; 127 (9): 878885878-85.

BackgroundAcute aortic dissection associated with cocaine use is rare and has been reported predominantly as single cases or in small patient cohorts.MethodsOur study analyzed 3584 patients enrolled in the International Registry of Acute Aortic Dissection from 1996 to 2012. We divided the population on the basis of documented cocaine use (C+) versus non cocaine use (C-) and further stratified the cohorts into type A (33 C+/2332, 1.4%) and type B (30 C+/1252, 2.4%) dissection.ResultsC+ patients presented at a younger age and were more likely to be male and black. Type B dissections were more common among C+ patients than in C- patients. Cocaine-related acute aortic dissection was reported more often at US sites than at European sites (86.4%, 51/63 vs 13.6%, 8/63; P < .001). Tobacco use was more prevalent in the C+ cohort. No differences were seen in history of hypertension, known atherosclerosis, or time from symptom onset to presentation. Type B C+ patients were more likely to be hypertensive at presentation. C+ patients had significantly smaller ascending aortic diameters at presentation. Acute renal failure was more common in type A C+ patients; however, mortality was significantly lower in type A C+ patients.ConclusionsCocaine use is implicated in 1.8% of patients with acute aortic dissection. The typical patient is relatively young and has the additional risk factors of hypertension and tobacco use. In-hospital mortality for those with cocaine-related type A dissection is lower than for those with non cocaine-related dissection, likely due to the younger age at presentation.Copyright © 2014 Elsevier Inc. All rights reserved.

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