title: Assessment of myocardial infarction by CT angiography and cardiovascular MRI in patients with cocaine-associated chest pain: a pilot study.
abstract: OBJECTIVE
  Cocaine is a commonly used illicit drug that leads to the most emergency department (ED) visits. Chest pain is the most common presentation, reported in 40% of patients. Our aim was to evaluate the incidence of previous myocardial infarction among young cocaine users (18-40 years) with cocaine-associated chest pain by the assessment of myocardial fibrosis by cardiovascular MRI. Second, we also intended to evaluate the coronary tree by CT angiography (CTA).
  
  
  METHODS
  24 cocaine users (22 males) who frequently complained about cocaine-associated chest pain underwent CTA and cardiovascular MRI. Mean age of patients was 29.7 years and most of them (79%) had frequently used inhalatory cocaine.
  
  
  RESULTS
  The calcium score turned out to be positive in only one patient (Agatston=54). Among the coronary segments evaluated, only one patient had calcified plaques at the anterior descending coronary artery (proximal and medium segments). Assessment of regional ventricular function by the evaluation of 17 segments was normal in all patients. None of the patients showed myocardial delayed enhancement, indicative of myocardial fibrosis. CTA therefore confirmed the low cardiovascular risk of these patients, since most of them (96%) had no atherosclerosis detected by this examination. Only one patient (4%) had coronary atherosclerosis detected, without significant coronary stenosis.
  
  
  CONCLUSIONS
  Cardiovascular MR did not detect the presence of delayed enhancement indicative of myocardial fibrosis among young cocaine users with low cardiovascular risk who had complained of cocaine-associated chest pain.
authors.affiliation: Cardiovascular CT and Magnetic Resonance Lab, Heart Institute (InCor), University of São Paulo, São Paulo, Brazil. karenparaschin@yahoo.com.br
authors.forename: K
authors.initials: K
authors.lastname: Paraschin
authors.forename: A
authors.initials: A
authors.lastname: Guerra De Andrade
authors.forename: J
authors.initials: J
authors.lastname: Rodrigues Parga
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002318:Cardiovascular Diseases / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000503:physiopathology; D002637:Chest Pain / Q000139:chemically induced / Q000175:diagnosis; D003042:Cocaine / Q000009:adverse effects*; D019970:Cocaine-Related Disorders / Q000150:complications* / Q000175:diagnosis; D017023:Coronary Angiography / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000503:physiopathology; D010865:Pilot Projects; D011446:Prospective Studies; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed / Q000379:methods; D055815:Young Adult
chemical_list: D003042:Cocaine