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(Circulation. 2002;105:1529.)
© 2002 American Heart Association, Inc.

Editorials

Cocaine-Related Aortic Dissection in Perspective

Kim A. Eagle, MD; Eric M. Isselbacher, MD; Roman W. DeSanctis, MD, and the International Registry for Aortic Dissection (IRAD) Investigators

From Massachusetts General Hospital, Boston, Mass (E.M.I., R.W.D.), and the University of Michigan Medical Center, Ann Arbor, Mich (K.A.E.).

Correspondence to Kim A. Eagle, MD, Division of Cardiology, TC 3910, University of Michigan Medical Center, 1500 E Medical Center Dr, Ann Arbor, MI 48109-0374. E-mail keagle@umich.edu

Key Words: Editorials • cocaine • aorta • dissection

Cardiovascular complications of cocaine use have been ever more widely recognized and include the acceleration of atherosclerosis, coronary artery spasm, acute myocardial infarction, myocarditis, dilated cardiomyopathies, and cardiac arrhythmias. Less well known is the potentially lethal complication of aortic dissection. In the present issue of Circulation, Hsue and colleagues¹ report on their 20-year experience with acute aortic dissection at an inner-city hospital. Remarkably, their findings indicate that 14 (37%) of 38 patients treated for acute dissection reported having used cocaine in the minutes or hours preceding their presentation. Cocaine, particularly crack cocaine, seemed to have played a significant role in precipitating aortic dissection among this cohort of young (age 41±8.8 years), predominantly black (11 of 14; 79%), and hypertensive (11 of 14; 79%) individuals. This study represents the largest cohort of cocaine-related dissection ever reported. Its findings provoke a number of questions for those of us who study or manage this rare but highly lethal condition.

See p 1592

How common is cocaine-related aortic dissection? Previous reports predominantly have been descriptions of a single patient² or a summary of individual case reports.³ The presumption has been that cocaine is a very rare cause of a very rare condition. The report by Hsue et al¹ would seem to challenge that logic, but the authors freely admit that the inner-city population served by their hospital likely is responsible for this. In fact, because they accumulated only 14 patients over 20 years at their hospital, a cocaine-related dissection was encountered less than . . . [Full Text of this Article]

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