title: Prevalence, clinical characteristics and risk of myocardial infarction in patients with cocaine-related chest pain.
abstract: OBJECTIVE
  To investigate the frequency of recent cocaine use in patients attending an emergency department for acute chest pain, to describe the clinical characteristics of these patients, and to estimate the incidence of acute coronary syndrome in this population.
  
  
  METHODS
  Observational cohort study using a standard questionnaire that includes items on recent cocaine consumption.
  
  
  RESULTS
  During a 1-year period, 1240 patients aged under 55 years presented with chest pain. Of these, 63 (5%) had cocaine-related chest pain (7% of men and 1.8% of women). These patients were younger (35+/-10 years vs. 39+/-10 years; P=.002), were more frequently male (87% vs. 62%; P< .001), and were more frequently smokers (59% vs. 35%; P< .001). Patients who had used cocaine recently had a higher incidence of acute myocardial infarction (16 vs. 4%; P< .001), especially ST-segment-elevation myocardial infarction (11.1% vs. 1.6%; P< .01). After adjusting for coronary risk factors, history of cardiovascular disease and previous treatment, the odds ratio for myocardial infarction with recent cocaine consumption was 4.3 (95% confidence interval, 2-9.4).
  
  
  CONCLUSIONS
  Cocaine-related chest pain is often encountered in emergency departments, especially in men aged under 55 years. It is associated with a four-fold increase in the risk of acute myocardial infarction. All male patients aged under 55 years with acute chest pain should be asked about cocaine use.
authors.affiliation: Servicio de Cardiología, Institut del Tórax, Hospital Clínic e Institut d'Investigacions Biomèdiques August Pi i Sunyer, Departamento de Medicina, Universidad de Barcelona, Barcelona, España. xbosch@clinic.ub.es
authors.forename: Xavier
authors.initials: X
authors.lastname: Bosch
authors.forename: Pablo
authors.initials: P
authors.lastname: Loma-Osorio
authors.forename: Eduard
authors.initials: E
authors.lastname: Guasch
authors.forename: Santiago
authors.initials: S
authors.lastname: Nogué
authors.forename: José T
authors.initials: JT
authors.lastname: Ortiz
authors.forename: Miquel
authors.initials: M
authors.lastname: Sánchez
mesh_terms: D000328:Adult; D002637:Chest Pain / Q000209:etiology; D019970:Cocaine-Related Disorders / Q000150:complications*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000453:epidemiology* / Q000209:etiology; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors