Cocaine-related sudden death: a prospective investigation in south-west Spain -- Lucena et al., 10.1093/eurheartj/ehp557 -- European Heart Journal

European Heart Journal Advance Access published online on January 12, 2010
European Heart Journal, doi:10.1093/eurheartj/ehp557

Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2010. For permissions please email: journals.permissions@oxfordjournals.org

Cocaine-related sudden death: a prospective investigation in south-west Spain
Joaquin Lucena1,*, Mario Blanco1, Carmen Jurado2, Antonio Rico1, Manuel Salguero2, Rafael Vazquez3, Gaetano Thiene4 and Cristina Basso4
1 Forensic Pathology Service, Institute of Legal Medicine, Seville, Spain
2 National Institute of Toxicology and Forensic Sciences, Seville, Spain
3 Cardiology Service, Puerta del Mar University Hospital, Cadiz, Spain
4 Cardiovascular Pathology, Department of Medical Diagnostic Sciences and Special Therapies, University of Padua Medical School, Padua, Italy

Received 29 May 2009; revised 12 October 2009; accepted 26 November 2009 * Corresponding author. Avda. Sanchez Pizjuan s/n, Sevilla 41009 Spain. Tel: +34 955928022, Fax: +34 955928023, Email: joaquin.lucena@gmail.com


Aims: With an estimated 12 million consumers in Europe, cocaine (COC) is the illicit drug leading to the most emergency department visits. The aim of this study was to examine a consecutive series of sudden deaths (SDs) to focus on the prevalence, the toxicological characteristics, and the causes of death in COC-related fatalities.

Methods and results: Prospective case–control study of forensic autopsies was carried out in the time interval November 2003 to June 2006 at the Institute of Legal Medicine, Seville, south-west Spain, with a reference population of 1 875 462 inhabitants. Toxicology included blood ethanol analysis and blood and urine investigation for drugs of abuse and medical drugs. Autopsy was performed according to the European standardized protocol. Ten age- and sex-matched patients who died of violent causes with no antecedents of COC consumption and negative toxicology served as controls. During the study period, 2477 forensic autopsies were performed, including 1114 natural deaths. Among the latter, 668 fulfilled the criteria of SD and 21 (all males, mean age 34.6 ± 7.3 years) resulted to be COC-related (3.1%). Cocaine was detected in 67.1% of the blood (median 0.17 mg/L, interquartile range 0.08–0.42) and in 83.0% of the urine samples (median 1.15 mg/L, interquartile range 0.37–17.34). A concomitant use of ethanol was found in 76.0% and cigarette smoking in 81.0%. Causes of SD were cardiovascular in 62.0%, cerebrovascular in 14.0%, excited delirium in 14.0%, respiratory and metabolic in 5.0% each. Left ventricular hypertrophy was observed in 57.0%, small vessels disease in 42.9%, severe atherosclerotic coronary artery disease in 28.6%, and coronary thrombosis in 14.3%.

Conclusion: Systematic toxicology investigation indicates that 3.1% of SDs are COC-related and are mainly due to cardio-cerebrovascular causes. Left ventricular hypertrophy, small vessel disease, and premature coronary artery atherosclerosis, with or without lumen thrombosis, are frequent findings that may account for myocardial ischaemia at risk of cardiac arrest in COC addicts.


Key Words: Cocaine • Death sudden • Epidemiology • Pathology • Toxicology

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Cocaine-related sudden death: a prospective investigation in south-west Spain -- Lucena et al., 10.1093/eurheartj/ehp557 -- European Heart Journal