title: Prevalence of cocaine use among patients attending the emergency department with chest pain.
abstract: BACKGROUND
  Cocaine is the only drug to show a rise in misuse between 1996 and 2007 in England and Wales. It can cause chest pain and myocardial infarction. This study assessed the prevalence of cocaine use in patients presenting with chest pain, and determined the association between cocaine use and chest pain.
  
  
  METHODS
  Patients presenting with chest pain had a urine sample collected at presentation. Each patient with chest pain was matched with a non-chest pain control. Demographic detail, drug history and clinical outcome was recorded, samples anonymised and subsequently tested for cocaine and metabolites.
  
  
  RESULTS
  Of the 1469 patients, 101 (6.9%) tested positive for cocaine compared with 3.8% of controls (p<0.001). Men (8%) were more likely than women (5.1%) to test positive for cocaine. Two patients developed a myocardial infarction. Cocaine use was highest in those aged 18-30 years for both sexes and decreased with age. Cocaine-positive patients with chest pain were more likely to present in the evening, after midnight or at the weekend. Only 18% of all patients presenting with chest pain had a specific drug history recorded in their notes.
  
  
  CONCLUSIONS
  As many patients do not admit to use of an illegal drug, routine testing would enable cocaine-related ischaemic events to be identified more easily but this remains controversial. As management of cocaine-induced chest pain is different from other causes of chest pain, doctors should routinely question patients with chest pain about cocaine use in addition to well recognised risk factors.
authors.affiliation: West Middlesex University Hospital, Twickenham Road, Isleworth, London, TW7 6AF, UK. tanyamaric@hotmail.com
authors.forename: Tanya
authors.initials: T
authors.lastname: Maric
authors.forename: Sally
authors.initials: S
authors.lastname: O'Connor
authors.forename: Noel
authors.initials: N
authors.lastname: Pollock
authors.forename: Zul
authors.initials: Z
authors.lastname: Mirza
authors.forename: John
authors.initials: J
authors.lastname: Henry
mesh_terms: D000293:Adolescent; D000328:Adult; D002637:Chest Pain / Q000453:epidemiology* / Q000209:etiology; D019970:Cocaine-Related Disorders / Q000150:complications / Q000453:epidemiology*; D003955:Diagnostic Tests, Routine; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008487:Medical History Taking / Q000592:standards; D010343:Patient Admission / Q000706:statistics & numerical data / Q000639:trends; D012307:Risk Factors; D017678:Sex Distribution; D016896:Treatment Outcome; D014852:Wales / Q000453:epidemiology