title: Management of Cocaine-Induced Myocardial Infarction: 4-Year Experience at an Urban Medical Center.
abstract: OBJECTIVE
  In 2008, the American Heart Association and the American College of Cardiology released guidelines for the management of cocaine-induced myocardial infarction (CIMI). We hypothesized that CIMI patients are likely to receive less invasive and more conservative management than patients with MI without history of cocaine use.
  
  
  METHODS
  We conducted a retrospective analysis on patients younger than 65 years presenting with acute MI between April 1, 2008 and December 31, 2012. Patients were classified as cocaine-negative MI or CIMI based on either urine toxicology results or self-reported cocaine use. Categorical and continuous variables were compared using χ(2) or t test as appropriate. The primary outcome was cardiac catheterization or stress testing. The secondary outcome was a 30-day readmission rate for major adverse cardiovascular events. Multiple logistic regression models calculated odds ratios (ORs) for the primary outcomes adjusting for patient demographics and comorbidities.
  
  
  RESULTS
  Of 378 MI patients, 4.2 % had CIMI. CIMI patients were younger (50 vs 54 years; P < 0.01) predominantly African American (56% vs 16%, P < 0.01), and mostly active smokers (88% vs 58%, P = 0.02). They were more likely to receive stress testing (adjusted OR 3.61, 95% confidence interval 1.04-12.53) and less likely to undergo cardiac catheterization (adjusted OR 0.12, 95% confidence interval 0.03-0.45). The 30-day readmission rate for major adverse cardiovascular events was higher in CIMI compared with cocaine-negative MI patients (38% vs 13%; P = 0.03).
  
  
  CONCLUSIONS
  The use of cocaine in patients presenting with acute MI appears to impact management decisions of providers. Patient-centered postdischarge arrangements need better coordination for this patient group to optimize their follow-up care.
authors.affiliation: From the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Johns Hopkins Hospital, Division of Cardiology, Baltimore, Maryland, and the Department of Medicine, Saint Vincent Hospital, Worcester, Massachusetts.
authors.forename: Abednego
authors.initials: A
authors.lastname: Chibungu
authors.affiliation: From the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Johns Hopkins Hospital, Division of Cardiology, Baltimore, Maryland, and the Department of Medicine, Saint Vincent Hospital, Worcester, Massachusetts.
authors.forename: Venkat
authors.initials: V
authors.lastname: Gundareddy
authors.affiliation: From the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Johns Hopkins Hospital, Division of Cardiology, Baltimore, Maryland, and the Department of Medicine, Saint Vincent Hospital, Worcester, Massachusetts.
authors.forename: Scott M
authors.initials: SM
authors.lastname: Wright
authors.affiliation: From the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Johns Hopkins Hospital, Division of Cardiology, Baltimore, Maryland, and the Department of Medicine, Saint Vincent Hospital, Worcester, Massachusetts.
authors.forename: Chike
authors.initials: C
authors.lastname: Nwabuo
authors.affiliation: From the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Johns Hopkins Hospital, Division of Cardiology, Baltimore, Maryland, and the Department of Medicine, Saint Vincent Hospital, Worcester, Massachusetts.
authors.forename: Preetam
authors.initials: P
authors.lastname: Bollampally
authors.affiliation: From the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Johns Hopkins Hospital, Division of Cardiology, Baltimore, Maryland, and the Department of Medicine, Saint Vincent Hospital, Worcester, Massachusetts.
authors.forename: Regina
authors.initials: R
authors.lastname: Landis
authors.affiliation: From the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Johns Hopkins Hospital, Division of Cardiology, Baltimore, Maryland, and the Department of Medicine, Saint Vincent Hospital, Worcester, Massachusetts.
authors.forename: Shaker M
authors.initials: SM
authors.lastname: Eid
mesh_terms: D001741:Black or African American; D006328:Cardiac Catheterization; D019970:Cocaine-Related Disorders / Q000150:complications*; D015331:Cohort Studies; D005080:Exercise Test; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D010359:Patient Readmission; D012008:Recurrence; D012189:Retrospective Studies; D012907:Smoking