Is cocaine use recognised as a risk factor for acute coronary syndrome by doctors in the UK?
BACKGROUND
Cocaine is a sympathomimetic agent that can cause coronary artery vasospasm leading to myocardial ischaemia, acute coronary syndrome and acute myocardial infarction (ACS/AMI). The management of cocaine-induced ACS/AMI is different to classical atheromatous ACS/MI, because the mechanisms are different.


METHODS
Knowledge study--Junior medical staff were given a scenario of a patient with ACS and asked to identify potential risk factors for ACS and which ones they routinely asked about in clinical practice. Retrospective study--Retrospective notes reviews of patients with suspected and proven (elevated troponin T concentration) ACS were undertaken to determine the recording of cocaine use/non-use in clinical notes.


RESULTS
Knowledge study--There was no significant difference in the knowledge that cocaine was a risk factor compared to other "classical" cardiovascular risk factors, but juniors doctors were less likely to ask routinely about cocaine use compared to other "classical" risk factors (52.9% vs >90%, respectively). Retrospective study--Cocaine use or non-use was documented in 3.7% (4/109) and 4% (2/50) of clinical notes of patients with suspected and proven ACS, respectively.


CONCLUSIONS
Although junior medical staff are aware that cocaine is a risk factor for ACS/AMI, they are less likely to ask about it in routine clinical practice or record its use/non-use in clinical notes. It is essential that patients presenting with suspected ACS are asked about cocaine use, since the management of these patients is different to those with ACS secondary to "classical" cardiovascular risk factors.
Wood
David M
DM
Guy's and St Thomas Poisons Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK. david.wood@gstt.nhs.uk
Hill
Duncan
D
Gunasekera
Awini
A
Greene
Shaun L
SL
Jones
Alison L
AL
Dargan
Paul I
PI
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000789:Angina, Unstable / Q000209:etiology*; D019970:Cocaine-Related Disorders / Q000150:complications* / Q000175:diagnosis; D003329:Coronary Vasospasm / Q000139:chemically induced; D004522:Educational Status; D005260:Female; D006801:Humans; D008297:Male; D008487:Medical History Taking; D008505:Medical Staff, Hospital / Q000193:education; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology*; D012307:Risk Factors; D006113:United Kingdom