title: Coronary angiographic findings in patients with cocaine-associated chest pain.
abstract: Patients who present to the Emergency Department (ED) with chest pain associated with cocaine use are a common problem. The incidence and predictors of underlying significant coronary disease in patients with and without myocardial infarction (MI) has not been well described. Patients who underwent coronary angiography within 5 weeks of an ED evaluation for cocaine-associated chest pain were studied. Significant disease was defined as > or = 50% stenosis of a coronary artery or major branches or bypass graft. A total of 90 patients underwent coronary angiography. Significant disease was present in 45 (50%), with 1-vessel disease in 32%, 2-vessel disease in 10%, 3-vessel disease in 6%, with significant graft stenosis in 3%. Significant disease was present in 77% of patients with MI or troponin I elevations, compared to only 35% of patients without myonecrosis. Predictors of significant coronary disease included MI or troponin I elevations, prior MI, known coronary disease (prior MI or revascularization), and elevated cholesterol. Only 7 of the 39 patients (18%) without myonecrosis or a history of coronary disease had significant disease on angiography. In conclusion, significant disease is found in the majority of patients with cocaine-associated MI or troponin elevations. In contrast, only a minority of those without myonecrosis have significant coronary disease.
authors.affiliation: Virginia Commonwealth University Health System Medical College of Virginia, Richmond, Virginia, USA.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Kontos
authors.forename: Robert L
authors.initials: RL
authors.lastname: Jesse
authors.forename: James L
authors.initials: JL
authors.lastname: Tatum
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Ornato
mesh_terms: D000328:Adult; D017677:Age Distribution; D002637:Chest Pain / Q000000981:diagnostic imaging* / Q000209:etiology; D003042:Cocaine / Q000009:adverse effects*; D015331:Cohort Studies; D015897:Comorbidity; D017023:Coronary Angiography / Q000379:methods*; D004562:Electrocardiography; D004635:Emergency Medicine; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D017678:Sex Distribution; D019966:Substance-Related Disorders / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D015996:Survival Rate; D014336:Troponin
chemical_list: D014336:Troponin; D003042:Cocaine