Prognostic Impact of Recreational Drug Use on 1-Year Outcomes in NSTEMI and STEMI Patients
Abstract
Background: Recreational drug use is increasingly associated with adverse outcomes in acute coronary syndrome (ACS) patients, but differences in long-term outcomes between ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction are not well defined. Objective: The authors evaluated the association between recreational drug use and major adverse cardiovascular events (MACE) 1 year after intensive cardiac care unit (ICCU) admission in ACS patients. Methods: The Addiction in Intensive Cardiac Care Units study systematically screened all patients admitted to ICCUs across 39 French centers (April 7-22, 2021) via prospective urinary testing. The primary outcome was MACE, defined as cardiovascular death, nonfatal myocardial infarction, or stroke. One-year follow-up was collected through clinical visits or direct contact between patients and cardiologists, concluding in June 2022. Outcomes were adjudicated by an independent cardiology committee. The prognostic impact of recreational drug use on MACE was assessed using multivariable Cox proportional hazards models, validated by propensity matching. Results: Of 712 ACS patients, 13.5% had recreational drug detection. At 1 year, MACE occurred in 7.0%, with higher rates among drug-positive vs drug-negative patients (12.5% vs 6.2%). Recreational drug use was associated with increased MACE (HR: 2.70; 95% CI: 1.30-5.57; P = 0.013). This association was significant in STEMI (HR: 4.11; 95% CI: 1.60-10.5; P = 0.005) but not in non-ST-elevation myocardial infarction patients. Propensity matching confirmed this in STEMI patients (HR: 3.39; 95% CI: 1.19-9.62; P = 0.022). Conclusions: Recreational drug use was associated with increased 1-year MACE risk in ACS patients, particularly STEMI, supporting routine drug screening.
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BibTeX
@article{aboujaoude2026prognostic,
title = {{Prognostic Impact of Recreational Drug Use on 1-Year Outcomes in NSTEMI and STEMI Patients}},
author = {Michael Aboujaoude and Nefissa Hamache and Jean Guillaume Dillinger and Antonin Trimaille and Claire Bouleti and Clément Delmas and Guillaume Schurtz and Sonia Houssany-Pissot and Reza Rossanaly Vasram and Guillaume Bonnet and Damien Millischer and Christophe Thuaire and François Roubille and Nathalie Noirclerc and Stéphane Andrieu and Charles Fauvel and Raphael Mirailles and Julien Hudelo and Trecy Gonçalves and Jeremy Florence and Alexandre Unger and Manveer Singh and Emmanuel Gall and Alexandre Lafont and Solenn Toupin and Lynette Menezes and Eric Vicaut and Patrick Henry and Théo Pezel},
journal = {JACC. Advances},
year = {2026},
month = oct,
doi = {10.1016/j.jacadv.2025.102574},
url = {https://hal.science/hal-05481126v1},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Prognostic Impact of Recreational Drug Use on 1-Year Outcomes in NSTEMI and STEMI Patients
AU - Michael Aboujaoude
AU - Nefissa Hamache
AU - Jean Guillaume Dillinger
AU - Antonin Trimaille
AU - Claire Bouleti
AU - Clément Delmas
AU - Guillaume Schurtz
AU - Sonia Houssany-Pissot
AU - Reza Rossanaly Vasram
AU - Guillaume Bonnet
AU - Damien Millischer
AU - Christophe Thuaire
AU - François Roubille
AU - Nathalie Noirclerc
AU - Stéphane Andrieu
AU - Charles Fauvel
AU - Raphael Mirailles
AU - Julien Hudelo
AU - Trecy Gonçalves
AU - Jeremy Florence
AU - Alexandre Unger
AU - Manveer Singh
AU - Emmanuel Gall
AU - Alexandre Lafont
AU - Solenn Toupin
AU - Lynette Menezes
AU - Eric Vicaut
AU - Patrick Henry
AU - Théo Pezel
PY - 2026
DA - 2026/10/01
JO - JACC. Advances
DO - 10.1016/j.jacadv.2025.102574
UR - https://hal.science/hal-05481126v1
AB - Background: Recreational drug use is increasingly associated with adverse outcomes in acute coronary syndrome (ACS) patients, but differences in long-term outcomes between ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction are not well defined. Objective: The authors evaluated the association between recreational drug use and major adverse cardiovascular events (MACE) 1 year after intensive cardiac care unit (ICCU) admission in ACS patients. Methods: The Addiction in Intensive Cardiac Care Units study systematically screened all patients admitted to ICCUs across 39 French centers (April 7-22, 2021) via prospective urinary testing. The primary outcome was MACE, defined as cardiovascular death, nonfatal myocardial infarction, or stroke. One-year follow-up was collected through clinical visits or direct contact between patients and cardiologists, concluding in June 2022. Outcomes were adjudicated by an independent cardiology committee. The prognostic impact of recreational drug use on MACE was assessed using multivariable Cox proportional hazards models, validated by propensity matching. Results: Of 712 ACS patients, 13.5% had recreational drug detection. At 1 year, MACE occurred in 7.0%, with higher rates among drug-positive vs drug-negative patients (12.5% vs 6.2%). Recreational drug use was associated with increased MACE (HR: 2.70; 95% CI: 1.30-5.57; P = 0.013). This association was significant in STEMI (HR: 4.11; 95% CI: 1.60-10.5; P = 0.005) but not in non-ST-elevation myocardial infarction patients. Propensity matching confirmed this in STEMI patients (HR: 3.39; 95% CI: 1.19-9.62; P = 0.022). Conclusions: Recreational drug use was associated with increased 1-year MACE risk in ACS patients, particularly STEMI, supporting routine drug screening.
SN - 2772-963X
ER -