The effects of illicit stimulant drugs on acute type B aortic dissection outcomes

Objective Although the association between illicit stimulant use and aortic dissection from associated hypertension has been described, the impact on outcomes in acute type B dissection remains unclear. We sought to describe our experience with acute type B aortic dissection (TBAD) arising from illicit stimulant drug use. Methods A retrospective review of all acute Stanford type B dissections at a single institution from 2018 to 2023 was performed. Patients were stratified by stimulant use (methamphetamine and/or cocaine) identified by self-report or urinalysis. Outcomes included malperfusion, operative intervention during index hospitalization, major adverse cardiovascular events (MACEs), 30-day and in-hospital mortality (early dissection-related death), length of stay (LOS), dissection-related readmission, return for follow-up, and nonhome discharge. Results We included 89 patients who were admitted for acute TBAD; 41 (46%) were stimulant users. The stimulant group was younger (54.7 years vs 64.3 years; P = .0001) and more likely to have congestive heart failure (36.6% vs 10.4%; P = .003). Malperfusion was more prevalent in stimulant users (20 [49%] vs 11 [23%]; P = .011). Repair during index hospitalization trended toward higher frequency with illicit stimulant use (51.2% vs 39.6%; P = .29) and, when completed, repair was performed as urgent or emergent more often (95% vs 73%; P = .046). We found that 30-day MACEs occurred in 13 stimulant patients (31.7%) and 5 nonusers (10.4%) ( P = .0001). Hospital and intensive care unit LOS were longer in stimulant users (15.5 days vs 7.9 days [ P = .0004] and 9.3 days vs 5.2 days [ P = .0002], respectively). The stimulant group was less likely to follow up (41.5% vs 66.7%; P = .02) and more likely to have dissection-related readmission (46.3% vs 18.4%; P = .006). Stimulant users were also more likely to have nonhome discharge (34.1% vs 18.8%). One mortality occurred in the nonstimulant dissection group and zero in the stimulant dissection group. Conclusions In TBAD, illicit stimulant drug use is associated with increased rates of malperfusion as well as urgent and emergent repair, resulting in worse outcomes with higher rates of MACEs, longer LOS, risk for dissection-related readmission, and lower likelihood to follow-up. These data suggest that patients presenting with type B acute aortic dissection in the setting of illicit stimulant use are a higher risk population compared with those without stimulant use.