Stimulant drug use is associated with high-risk type B aortic dissections

Objective Acute Type B Dissections require prompt management to limit patient morbidity and mortality. Recent reporting standard changes described several "high-risk" criteria that predict short- and long-term patient survival, but these criteria do not include stimulant drug use such as methamphetamines or cocaine. Historical observations implicate these drugs in a low percentage of type B aortic dissections, but this may represent under-reporting in the setting of under-screening. We analyze institutional data to investigate the link between stimulant drug use and high-risk type B aortic dissections. Methods A retrospective review of medical records of 82 patients who presented with an acute type B aortic dissection was performed. Patients were included if there was documented evidence that they used or did not use stimulant drugs within 24 hours of the onset of acute aortic dissection symptoms. The primary outcomes included the incidence of high-risk features and complicated dissections. Secondary outcomes included one-year mortality, stroke, and major cardiovascular events. Results The final cohort included 24 patients (14 had stimulant-associated aortic dissections). In aggregate, there was a significantly higher prevalence of high-risk features among the stimulant-associated dissection population as compared to the non-stimulant-associated dissection population (86% vs. 30%, p=0.02). There were no differences in one-year mortality, stroke, or major cardiovascular events between the two groups. Conclusions These findings indicate a strong association between stimulant use and type B aortic dissections, with a notably higher incidence of high-risk features among stimulant users. The consistent co-occurrence suggests that stimulant use may play a significant role in the pathophysiology and natural history of type B aortic dissections, warranting its consideration in both clinical assessment and future research.