[9] Illicit Stimulant Abuse and Aortic Dissections in a Culturally Diverse Autopsy Population

Anthony P Martinez, Michelle Aurelius, Sarah Lathrop. University of New Mexico School of Medicine, Albuquerque, NM

Background: Stimulants such as methamphetamines and cocaine can be cardiotoxic by increasing heart rate, oxygen demand, and ventricular contractility. They are thought to predispose an already weakened aortic media to an aortic dissection by causing a catecholamine surge that raises the shear stress and increases the likelihood for intimal tears and dissection. Due to its relatively fixed position, a tear at the ligamentum artierosum, resulting in a type B dissection, is thought to be more likely with stimulant drug use. The purpose of this study is to report patients who died from acute aortic dissections in a culturally diverse autopsy population and determine if acute illicit stimulant drug use is associated with a Stanford type B dissection.
Design: A retrospective chart review was performed over a 33 year period in patients with aortic dissection. Among the 124 cases of dissection, clinical features, risk factors, and illicit stimulant drug abuse were determined and compared using the Stanford aortic dissection criteria. Wilcoxon rank-sum and either Fisher's exact or chi-square test were used for continuous and categorical variables, respectively.
Results: Aortic dissection is more common in the 6th and 7th decade with Stanford type A being more common. Hypertension is the most common risk factor. 24.5% of patients were seen by physicians for symptoms and released prior to their dissection. Illicit stimulant-related dissections represented 5.1% of cases. All illicit stimulant-related dissections were Type A and were not statistically different from non-stimulant dissections.

Aortic dissection characteristics
illicit stimulant use (n=8) non-illicit stimulant use (n=148) p value
Stanford Classification A8/8 (100%)Stanford Classification A95/116 (81/9%)0.35
History of hypertension6/8 (75%)History of hypertension78/148 (52.7%)0.29
History of smoking5/8 (62.5%)History of smoking50/148 (33.8%)0.13
Females3/8 (37.5%)Females49 (33.1%)1.0
Mean (median) age in years51 (48)Mean (median) age in years59.8 (61)0.11

Stanford Classification by Ethnicity (n=124)
 Stanford A (103)Stanford B (21)
p value0.81

Conclusions: All illicit stimulant-related dissections in this study were Type A. This differs from previous reports that found drug related dissections tended to be in younger, Black patients and were predominantly Type B. We highlight the need for routine toxicology on all aortic dissections regardless of history to provide more insight into illicit stimulant drugs and their role in aortic dissections.
Category: Autopsy

Wednesday, March 6, 2013 9:30 AM

Poster Session V # 9, Wednesday Morning


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