Cocaine-associated chest pain: how common is myocardial infarction?
OBJECTIVE
Prior studies addressing the incidence of acute myocardial infarction (AMI) in patients with cocaine-associated chest pain have found divergent results. Previous prospective studies, which found approximately a 6% incidence of AMI, have been criticized for selection bias. This study sought to determine the rate of AMI in patients with cocaine-associated chest pain.


METHODS
All patients seen in an urban university-affiliated hospital between July 1996 and February 1998 were identified by ICD-9 medical records search for cocaine use and chest pain/ acute coronary syndromes. In this system, all faculty admit all patients with cocaine-associated chest pain for at least 23-hour observation periods. Data collected included demographics, medical and cocaine use history, presenting characteristics, hospital course, cardiovascular complications, and diagnostic tests using a 119-item closed-question data instrument with high interrater reliability. The main outcome measure was AMI according to World Health Organization (WHO) criteria.


RESULTS
There were 250 patients identified with a mean age of 33.5 +/- 8.5 years; 77% were male; 84% were African American. Of 196 patients tested, 185 had cocaine or cocaine metabolites in the urine (94%). The incidence of cardiac risk factors were: hypercholesterolemia, 8%; diabetes, 6%; family history, 34%; hypertension, 26%; tobacco use, 77%; prior MI, 6%; and prior chest pain, 40%. Seventy-seven percent admitted to cocaine use in the preceding 24 hours: crack, 85%; IV, 2%; nasal, 6%. Twenty-five patients (10%) had electrocardiographic evidence of ischemia. A total of 15 patients experienced an AMI (6%; 95% CI = 4.1% to 8.9%) using WHO criteria. Complications were infrequent: bradydysrrhythmias, 0.4%; congestive heart failure, 0.4%; supraventricular tachycardia, 1.2%; sustained ventricular tachycardia, 0.8%.


CONCLUSIONS
The incidence of AMI was 6% in patients with cocaine-associated chest pain. This result is identical to that found in prior prospective studies.
Weber
J E
JE
Department of Emergency Medicine, Hurley Medical Center, Flint, MI 48503, USA. jwmd@umich.edu
Chudnofsky
C R
CR
Boczar
M
M
Boyer
E W
EW
Wilkerson
M D
MD
Hollander
J E
JE
D000328:Adult; D001794:Blood Pressure; D003042:Cocaine / Q000009:adverse effects* / Q000097:blood / Q000652:urine; D019970:Cocaine-Related Disorders / Q000453:epidemiology*; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D016347:Medical Records Systems, Computerized; D009203:Myocardial Infarction / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D014193:Trauma Centers
D003042:Cocaine