title: Relationship between cocaine use and coronary artery disease in patients with symptoms consistent with an acute coronary syndrome.
abstract: OBJECTIVE
  Observational studies of patients with cocaine-associated myocardial infarction have suggested more coronary disease than expected on the basis of patient age. The study objective was to determine whether cocaine use is associated with coronary disease in low- to intermediate-risk emergency department (ED) patients with potential acute coronary syndrome (ACS).
  
  
  METHODS
  The authors conducted a cross-sectional study of low- to intermediate-risk patients<60 years of age who received coronary computerized tomographic angiography (CTA) for evaluation of coronary artery disease (CAD) in the ED. Patients were classified into three groups with respect to CAD: maximal stenosis <25%, 25% to 49%, and ≥50%. Prespecified multivariate modeling (generalized estimating equations) was used to assess relationship between cocaine and CAD.
  
  
  RESULTS
  Of 912 enrolled patients, 157 (17%) used cocaine. A total of 231 patients had CAD ≥25%; 111 had CAD ≥50%. In univariate analysis, cocaine use was not associated with a lesion 25% or greater (12% vs. 14%; relative risk [RR]=0.89, 95% confidence interval [CI]=0.5 to 1.4) or 50% or greater (12% vs. 11%; RR=1.15, 95% CI=0.6 to 2.3). In multivariate modeling adjusting for age, race, sex, cardiac risk factors, and Thrombosis in Myocardial Infarction (TIMI) score, cocaine use was not associated with the presence of any coronary lesion (adjusted RR=0.95, 95% CI=0.69 to 1.31) or coronary lesions 50% or greater (adjusted RR=0.78, 95% CI=0.45 to 1.38). There was also no relationship between repetitive cocaine use and coronary calcifications or between recent cocaine use and CAD.
  
  
  CONCLUSIONS
  In symptomatic ED patients at low to intermediate risk of an ACS, cocaine use was not associated with an increased likelihood of coronary disease after adjustment for age, race, sex, and other risk factors for coronary disease.
authors.affiliation: Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Anna Marie
authors.initials: AM
authors.lastname: Chang
authors.forename: Kristy M
authors.initials: KM
authors.lastname: Walsh
authors.forename: Frances S
authors.initials: FS
authors.lastname: Shofer
authors.forename: Christine M
authors.initials: CM
authors.lastname: McCusker
authors.forename: Harold I
authors.initials: HI
authors.lastname: Litt
authors.forename: Judd E
authors.initials: JE
authors.lastname: Hollander
mesh_terms: D054058:Acute Coronary Syndrome; D000328:Adult; D002637:Chest Pain / Q000000981:diagnostic imaging; D019970:Cocaine-Related Disorders / Q000150:complications / Q000453:epidemiology*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000139:chemically induced / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors