QUANTITATIVE-ANALYSIS OF AMOUNTS OF CORONARY ARTERIAL NARROWING IN COCAINE ADDICTS

From January 1979 to February 1989, 22 cocaine addicts were studied at necropsy. The 22 patients were divided into 2 groups: death associated with increased cocaine levels at necropsy (13 patients, aged 23 to 45 years [mean 32], and mean total blood cocaine level, 0.36 mg/dl) and noncocaine-related death (9 patients, aged 15 to 50 years [mean 32]). Of the 22 patients, 17 were men and 5 were women; 19 were black and 3 were white. Gross examination in the 22 patients disclosed that 8 patients (36%) had 1 or more of the 4 major (left main, left anterior descending, left circumflex, and right) coronary arteries narrowed at some point >75% in cross-sectional area by atherosclerotic plaque. In 17 cases, the 4 major epicardial coronary arteries were divided into 805 five-mm long segments and a histologic section was prepared from each segment: of the 12 patients with a cocaine-related death, 41 (8%) of 544 five-mm coronary segments were narrowed 76 to 100% and 106 segments (19%) were narrowed 51 to 75% in cross-sectional area by plaque. Of the 5 cocaine addicts who did not die from cocaine overdose, 8 (3%) of 261 five-mm coronary segments were narrowed 76 to 100% and 19 segments (7%) were narrowed 51 to 75% in cross-sectional area by plaque. The frequency of coronary artery disease was greater in patients dying with cocaine in their blood at necropsy compared to those whose death was not cocaine related. Also the frequency of severe coronary arterial narrowing is considerably greater than expected for the entire group of patients whose mean age was only 32 years. Thus, either of 2 possibilities, alone or in combination, may explain our findings: coronary atherosclerosis is accelerated by cocaine addiction for reasons as yet undetermined, or cocaine provides a fatal stress in patients with premature coronary atherosclerosis from other causes. © 1990.