Ender ÖRNEK, Alparslan KURTUL, Murat GÖK

Genç akut miyokard infarktüslerinde metamfetamin ve kokain için idrar toksikoloji taramasının uygulanabilirliği

Amaç: Öyküsünde kokain ve metamfetamin kullanımı olan, akut miyokart enfarktüsü geçiren hastalarda tedavi stratejisi değişmektedir. Hastalar genellikle hastaneye kabulde yasa dışı uyuşturucu kullanımını kendi kendine bildirmeyebilirler ancak idrar analizi etyolojiyi ortaya çıkarabilir. Bu çalışma, genç yaşta akut miyokart enfarktüsü geçirenlerde kokain ve metamfetamin kullanımının idrar analizi ile rutin olarak taranmasının makul olup olmadığını araştırmayı amaçlamaktadır.Gereç ve Yöntemler: Çalışmaya akut miyokart enfarktüsü geçiren ardışık 50 genç hasta (≤50 yaşında) alındı. Hastaların yaş ortalaması 41.3 ± 7.8 (21-50) di ve hastaların% 80'i erkekti. Hastalar hastaneye kabul sırasında herhangi bir yasa dışı uyuşturucu kullanımının olup olmadığı hakkında sorgulandı. Kokain ve metamfetamin analizi için idrar örnekleri, yatışın ilk günü içinde immünolojik testler kullanılarak yapıldı. Benzoylecgonine seviyesi 300 ng / mL'nin üzerindeyse kokain kullanımı pozitif olarak kabul edildi. Eğer seviye 1000 ng / mL'nin üzerindeyse, metamfetamin kullanımı pozitif olarak kabul edildi. Tüm hastalara koroner anjiografi yapıldı ve ciddi koroner lezyonu olanlara perkütan koroner revaskülarizasyon uygulandı.Bulgular: 38 hastada (%76) ST yükselmeli akut miyokart enfarktüsü, 12 hastada (% 24) ST yükselmesiz akut miyokart enfarktüsü saptandı. Hiçbir hasta kendiliğinden kokanin ve metamfetamine kullandığını belirtmedi. 50 hastanın hiçbirinde idrar analizinde kokain saptanmadı. 5 hastada (%10) idrar metamfetamine düzeyi pozitif saptandı. Ateroskleroz için klasik risk faktörleri gruplar arasında benzerdi.Sonuç: Metamfetamin kullanımını %10 bulduğumuz için, daha genç miyokart infarktüsü geçiren hastalarda idrar analiziyle metamfetamin kullanımının taranması makul olabilir.

Anahtar Kelimeler:

idrar toksikolojisi, metamfetamin, akut miyokard enfarktüsü

Reasonability of urine toxicology screening for methamphetamine and cocaine in young acute myocardial infarction

Aim: Prior cocaine and methamphetamine use influence treatment strategies in subjects with acute myocardial infarction. Often patients may not self-report illicit drug use on admission but urine analysis may reveal etiology. This study aimed to investigate if routine screening of cocaine and methamphetamine use by urine analysis is reasonable in young myocardial infarction.Material and Methods: This study enrolled 50 consecutive young patients (≤50 years old) with acute myocardial infarction. Mean age was 41.3±7.8 (21-50) and 80% of patients were male. Patients were queried about the use of any illicit drug use on admission. Urine samples for cocaine and methamphetamine analysis were done using immunuassay tests within the first day of admission. Cocaine use was considered as positive if the level of benzoylecgonine was above 300 ng/mL. Methamphetamine use was considered as positive if the level was above 1000 ng/mL. All the patients underwent coronary angiography and percutaneous coronary revascularization if they had significant coronary artery stenosis.Results: ST elevated acute myocardial infarction was diagnosed in 38 patients (76%) and non-ST elevated acute myocardial infarction was diagnosed in 12 patients (24%). No patient self-reported cocaine or methamphetamine use. Urine analyses for cocaine were negative in all 50 patients. In urine analyses methamphetamine were found to be positive in 5 patients (10%). Classical risk factors for atherosclerosis were similar between the groups.Conclusion: As we found 10% incidence of methamphetamine use, it may be reasonable to screen methamphetamine use but not cocaine use by urine analysis in younger myocardial infarction patients

Keywords:

methamphetamine, urine toxicology, acute myocardial infarction,

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