title: Cocaine-associated myocardial infarction. Mortality and complications. Cocaine-Associated Myocardial Infarction Study Group.
abstract: BACKGROUND
  The frequency of complications in patients with cocaine-associated myocardial infarction is unknown. This study was performed to determine the short-term morbidity and mortality secondary to cocaine-associated myocardial infarction.
  
  
  METHODS
  We performed a retrospective cohort study at 29 hospital centers throughout the United States. Patients with cocaine-associated myocardial infarction that occurred between 1987 and 1993 were identified through record review. The primary outcome measures were in-hospital mortality and the incidence and timing of major cardiovascular complications.
  
  
  RESULTS
  Cocaine-associated myocardial infarction was identified 136 times in 130 patients. Patients were generally young (mean age, 38 years), nonwhite (72%), tobacco smokers (91%) with a history of cocaine use in the past 24 hours (88%). The initial electrocardiogram disclosed infarction in 44% and ischemia in an additional 18% of patients. Myocardial infarctions were evenly distributed between anterior (45%) and inferior (44%) and were most often non-Q-wave (61%). Complications occurred 64 times in 49 patients (36%; 95% confidence interval, 28% to 44%), including congestive heart failure in nine patients, ventricular tachycardia in 23 patients, supraventricular tachycardia in six patients, and brady-dysrhythmias in 26 patients. Most patients who had complications (90%) had them within 12 hours of presentation. Acute in-hospital mortality was 0% (95% confidence interval, 0% to 2%).
  
  
  CONCLUSIONS
  The mortality of patients hospitalized with cocaine-associated myocardial infarction was low. The majority of complications occurred within 12 hours of presentation.
authors.affiliation: Department of Emergency Medicine, University Medical Center, Stony Brook, NY, USA.
authors.forename: J E
authors.initials: JE
authors.lastname: Hollander
authors.forename: R S
authors.initials: RS
authors.lastname: Hoffman
authors.forename: J L
authors.initials: JL
authors.lastname: Burstein
authors.forename: R D
authors.initials: RD
authors.lastname: Shih
authors.forename: H C
authors.initials: HC
authors.lastname: Thode
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006331:Heart Diseases / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000139:chemically induced* / Q000150:complications* / Q000401:mortality; D012189:Retrospective Studies; D013997:Time Factors