Prevalence of psychoactive drug use in patients hospitalized for acute cardiac events: Rationale and design of the ADDICT-ICCU trial, from the Emergency and Acute Cardiovascular Care Working Group and the National College of Cardiologists in Training of the French Society of Cardiology - 23/09/22

Doi : 10.1016/j.acvd.2022.05.012

Jean-Guillaume Dillinger ^a,^{^{1
Jean-Guillaume Dillinger and Théo Pezel contributed equally.}}, Théo Pezel ^a,^{^{1
Jean-Guillaume Dillinger and Théo Pezel contributed equally.}}, Charles Fauvel ^b, Clément Delmas ^c, Guillaume Schurtz ^d, Antonin Trimaille ^e, Edouard Gerbaud ^f,^ac, Vincent Roule ^g, Jean-Claude Dib ^h, Albert Boccara ⁱ, Damien Millischer ^j, Christophe Thuaire ^k, Julien Fabre ^l, Thomas Levasseur ^m, Tanissia Boukertouta ⁿ, Arthur Darmon ^o, Ruben Azencot ^p, Benoit Merat ^q, Marie Haugel-Moreau ^r, Alain Grentzinger ^s, Clément Charbonnel ^t, Cyril Zakine ^u, Marc Bedossa ^v, Benoît Lattuca ^w, François Roubille ^x, Victor Aboyans ^y, Etienne Puymirat ^z, Ariel Cohen ^aa, Eric Vicaut ^ab, Patrick Henry ^a,^⁎
for the ADDICT-ICCU investigators
^a Department of Cardiology, Hôpital Lariboisière, AP–HP, Université de Paris Cité, Inserm U-942, 75010 Paris, France
^b Department of Cardiology, Rouen University Hospital, 76000 Rouen, France
^c Intensive Cardiac Care Unit, Rangueil University Hospital, 31000 Toulouse, France
^d Department of Cardiology, University Hospital of Lille, 59000 Lille, France
^e Department of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, 67000 Strasbourg, France
^f Cardiology Intensive Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut-Lévêque, 33604 Pessac Cedex, France
^g Department of Cardiology, Caen University Hospital, 14000 Caen, France
^h Département de Cardiologie, Clinique Ambroise Paré, 92200 Neuilly-sur-Seine, France
ⁱ Department of Cardiology, Andre Gregoire Hospital, 93100 Montreuil, France
^j Service de Cardiologie, Hôpital Montfermeil, 93370 Montfermeil, France
^k Service de Cardiologie, Centre Hospitalier de Chartres, 28630 Le Coudray, France
^l Department of Cardiology, University Hospital of Martinique, 97261 Fort-de-France, France
^m Service de Cardiologie, Centre Hospitalier de Fréjus/Saint-Raphaël, 83600 Fréjus, France
ⁿ Department of Cardiology, Hôpital Avicenne, AP–HP, 75011 Paris, France
^o Department of Cardiology, Hôpital Bichat, AP–HP, Université de Paris Cité, 75018 Paris, France
^p Service de Cardiologie, Hôpital Cochin, AP–HP, 75014 Paris, France
^q Service de Cardiologie et Médecine Aéronautique, Hôpital d’Instruction des Armées Percy, 92140 Clamart, France
^r Service de Cardiologie, Hôpital Ambroise Paré, AP–HP, 92012 Boulogne-Billancourt, France
^s Service de Cardiologie, Centre Hospitalier de Saintonge, 17100 Saintes, France
^t Service de Cardiologie, Hôpital Mignot, 78000 Versailles, France
^u Clinique Saint Gatien Alliance (NCT+), 37540 Saint-Cyr-sur-Loire, France
^v Service de Cardiologie et Maladies Vasculaires, CHU de Rennes, 35000 Rennes, France
^w Department of Cardiology, Nîmes University Hospital, Montpellier University, 30029 Nîmes, France
^x Department of Cardiology, CHU de Montpellier, 34000 Montpellier, France
^y Department of Cardiology, Dupuytren University Hospital; and Inserm U1094 & IRD U270, Limoges University, 87000 Limoges, France
^z Department of Cardiology, Hôpital Européen Georges Pompidou (HEGP), AP–HP, 75015 Paris, France
^aa Service de Cardiologie, Hôpital Saint-Antoine, AP–HP, 75012 Paris, France
^ab Unité de Recherche Clinique, Hôpital Fernand Widal, AP–HP, 75010 Paris, France
^ac Bordeaux Cardio-Thoracic Research Centre, U1045, Bordeaux University, 33000 Bordeaux, France

^⁎Corresponding author at: Lariboisiere Hospital, AP–HP, Université de Paris, 2, rue Ambroise Paré, 75010 Paris, France.Lariboisiere Hospital, AP–HP, Université de Paris2, rue Ambroise ParéParis75010France

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Graphical abstract

Study design of the ADDICT-ICCU study, a nationwide prospective multicentre study involving 39 centres throughout France, evaluating the prevalence of psychoactive drugs detected in consecutive patients hospitalized in an intensive cardiac care unit (ICCU) for an acute cardiovascular event. Detection of illicit (cannabinoids, cocaine, amphetamines, ecstasy, heroin and other opioids) and non-illicit (barbiturates, benzodiazepines, tricyclic antidepressant drugs, methadone and buprenorphine) psychoactive drugs will be performed through urine analysis using NarcoCheck® (Kappa City Biotech SAS, Montluçon, France) within 2hours of admission to the ICCU. MACE: major adverse cardiovascular events.

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Highlights

•	Psychoactive drug use is a public health concern.
•	Psychoactive drug use is prevalent and increases the risk of CV events.
•	Psychoactive drug use can induce acute CV events.
•	Prevalence of psychoactive drug use in patients hospitalized in an ICCU is unknown.
•	ADDICT-ICCU will assess this prevalence by systematic urinary drug screening.
•	Consecutive patients hospitalized in ICCU for an acute CV event will be screened.

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Summary

Background

Psychoactive drugs, including illicit drugs, are associated with an increased rate of cardiovascular events. The prevalence and outcome of patients using these drugs at the time of admission to an intensive cardiac care unit is unknown.

Aim

To assess the prevalence of psychoactive drugs detected in consecutive patients hospitalized in an intensive cardiac care unit for an acute cardiovascular event.

Methods

This is a nationwide prospective multicentre study, involving 39 centres throughout France, including all consecutive patients hospitalized in an intensive cardiac care unit within 2weeks. Psychoactive drug use will be assessed systematically by urine drug assay within 2hours of intensive cardiac care unit admission, to detect illicit (cannabinoids, cocaine, amphetamines, ecstasy, heroin and other opioids) and non-illicit (barbiturates, benzodiazepines, tricyclic antidepressants, methadone and buprenorphine) psychoactive drugs. Smoking will be investigated systematically by exhaled carbon monoxide measurement, and alcohol consumption using a standardized questionnaire. In-hospital major adverse events, including death, resuscitated cardiac arrest and cardiogenic shock, will be recorded. After discharge, all-cause death and major adverse cardiovascular events will be recorded systematically and adjudicated at 12months of follow-up.

Results

The primary outcome will be the prevalence of psychoactive drugs detected by systematic screening among all patients hospitalized in an intensive cardiac care unit. The in-hospital major adverse events will be analysed according to the presence or absence of detected psychoactive drugs. Subgroup analysis stratified by initial clinical presentation and type of psychoactive drug will be performed.

Conclusions

This is the first prospective multicentre study to assess the prevalence of psychoactive drugs detected by systematic screening in consecutive patients hospitalized for acute cardiovascular events.

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Keywords : Psychoactive drug, Illicit drug, Addiction, Intensive cardiac care unit, Prevalence

Abbreviations : EMCDDA, FACE, ICCU, MACE, QFR

Plan

Background

Methods

Study design and population

Detection of psychoactive drug use

Collection of baseline characteristics

Angiographic core laboratory

Disclosure of interest

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