Cocaine use in the general population has increased in recent years and although cardiovascular effects of cocaine have been investigated, cocaine-related sudden cardiac arrest (SCA) in the overall community has been described only through forensic studies.

In this prospective ongoing multicentre population-based registry, all SCA alive at hospital admission over a 5-year period were prospectively enrolled. Cocaine-associated SCA were compared to other causes of SCA in terms of characteristics, management and outcomes.

Among the 3028 SCAs admitted alive out of a total of 18,622 out-of-hospital cardiac arrests from May 2011 to May 2016, 32 SCAs (1.1%) were eventually associated with cocaine use, including 18 (56.3%) after acute use. Compared to SCA from other cause, cocaine-related SCA victims were younger (44.1 vs. 59.3 years, P<0.001), with greater proportion of males (87.5 vs. 73.0%, P=0.058), lesser known coronary artery disease (0 vs. 18.4%, P<0.001), but significantly more frequent active smokers (65.6 vs. 30.2%, P<0.001). The main underlying mechanisms of cocaine-associated SCA were acute myocardial ischemia (13/27 cases, 48.1%), including coronary spasm in 8 cases (61.5%), followed by multiple drug intoxication (18.5%), hypoxic causes (11.1%), pulmonary embolism (7.4%) and miscellaneous. SCA characteristics, initial and in-hospital management as well as survival rate (28.1% vs. 26.8%; P=0.84) were not significantly different in cocaine-associated.

In the general population, cocaine-associated SCA is a rare cause of SCA (1.1%), mostly occurring in young actively smoking men, immediately after acute use in more than half of cases. Coronary spasm, though representing the principal underlying mechanism, explains finally only one third of cocaine-associated SCA.