title: Comparison of in-hospital outcomes for beta-blocker use versus non-beta blocker use in patients presenting with cocaine-associated chest pain.
abstract: Beta blockers are indicated for management of acute coronary syndromes, but they generally are withheld in patients with cocaine-associated chest pain because of concerns for adverse outcomes related to the unique physiological effects of cocaine. Because few clinical studies have evaluated this interaction, we identified patients with toxicology screen results positive for cocaine treated for chest pain at 2 academic hospitals. Clinical characteristics and in-hospital outcomes were compared between patients with and without β-blocker therapy. We then constructed propensity scores to evaluate the independent relation between β-blocker use and the composite primary end point of myocardial infarction, stroke, ventricular arrhythmia, or all-cause mortality after adjusting for clinical characteristics. Of 376 consecutive patients with cocaine-related chest pain, β blockers were used in 164 (44%). Compared with no β blockers, patients treated with β blockers were more likely to describe anginal chest pain, to have known cardiovascular risk factors, and to receive other antiatherosclerotic therapies. Despite these higher risk clinical characteristics, patients treated with β blockers experienced similar peak troponin levels, individual adverse events, and rates of the composite primary end point (15.9% vs 12.3%, p = 0.32). The primary end point also was similar after propensity score analysis (odds ratio 1.37, 95% confidence interval 0.64 to 2.93, p = 0.42), including specific comparisons of beta-1 selective (odds ratio 1.83, 95% confidence interval 0.79 to 4.24) and nonselective (odds ratio 0.90, 95% confidence interval 0.33 to 2.42) β blockers, when compared with patients not receiving β blockers. In conclusion, no differences in outcomes were observed between patients treated versus not treated with β-blocker therapy in the setting of cocaine-related chest pain.
authors.affiliation: Division of Cardiology, Christiana Care Health System, Newark, Delaware.
authors.forename: Zaher
authors.initials: Z
authors.lastname: Fanari
authors.affiliation: Saint Luke's Mid America Heart and Vascular Institute, Kansas City, Missouri.
authors.forename: Kevin K
authors.initials: KK
authors.lastname: Kennedy
authors.affiliation: Center for Comprehensive Cardiovascular Care, Saint Louis University, St. Louis, Missouri.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Lim
authors.affiliation: Center for Comprehensive Cardiovascular Care, Saint Louis University, St. Louis, Missouri.
authors.forename: Abhay A
authors.initials: AA
authors.lastname: Laddu
authors.affiliation: Center for Comprehensive Cardiovascular Care, Saint Louis University, St. Louis, Missouri. Electronic address: jstolker@yahoo.com.
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Stolker
mesh_terms: D058668:Adrenergic alpha-1 Receptor Antagonists / Q000627:therapeutic use*; D058671:Adrenergic beta-1 Receptor Antagonists / Q000627:therapeutic use*; D000328:Adult; D002637:Chest Pain / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D003042:Cocaine / Q000009:adverse effects* / Q000493:pharmacokinetics; D019970:Cocaine-Related Disorders / Q000150:complications* / Q000188:drug therapy / Q000652:urine; D003937:Diagnosis, Differential; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D012189:Retrospective Studies; D016896:Treatment Outcome; D016482:Urinalysis
chemical_list: D058668:Adrenergic alpha-1 Receptor Antagonists; D058671:Adrenergic beta-1 Receptor Antagonists; D003042:Cocaine