title: Hospital Admissions for Chest Pain Associated with Cocaine Use in the United States.
abstract: The outcomes related to chest pain associated with cocaine use and its burden on the healthcare system are not well studied.
  
  
  
  Data were collected from the Nationwide Inpatient Sample (2001-2012). Subjects were identified by using the International Classification of Diseases, Ninth Revision, Clinical Modification codes. Primary outcome was a composite of mortality, myocardial infarction, stroke, and cardiac arrest.
  
  
  
  We identified 363,143 admissions for cocaine-induced chest pain. Mean age was 44.9 (±21.1) years with male predominance. Left heart catheterizations were performed in 6.7%, whereas the frequency of acute myocardial infarction and percutaneous coronary interventions were 0.69% and 0.22%, respectively. The in-hospital mortality was 0.09%, and the primary outcome occurred in 1.19% of patients. Statistically significant predictors of primary outcome included female sex (odds ratio [OR], 1.16; confidence interval [CI], 1.00-1.35; P = .046), age >50 years (OR, 1.24, CI, 1.07-1.43; P = .004), history of heart failure (OR, 1.63, CI, 1.37-1.93; P <.001), supraventricular tachycardia (OR, 2.94, CI, 1.34-6.42; P = .007), endocarditis (OR, 3.5, CI, 1.50-8.18, P = .004), tobacco use (OR, 1.3, CI, 1.13-1.49; P <.001), dyslipidemia (OR, 1.5, CI, 1.29-1.77; P <.001), coronary artery disease (OR, 2.37, CI, 2.03-2.76; P <.001), and renal failure (OR, 1.27, CI, 1.08-1.50; P = .005). The total annual projected economic burden ranged from $155 to $226 million with a cumulative accruement of more than $2 billion over a decade.
  
  
  
  Hospital admissions due to chest pain and concomitant cocaine use are associated with low rates of adverse outcomes. For the low-risk cohort in whom acute coronary syndrome has been ruled out, hospitalization may not be beneficial and may result in unnecessary cardiac procedures.
authors.affiliation: Interventional Cardiology, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass. Electronic address: vikas.dr.singh@gmail.com.
authors.forename: Vikas
authors.initials: V
authors.lastname: Singh
authors.affiliation: Cardiovascular Division, University of Miami Miller School of Medicine, Fla.
authors.forename: Alex P
authors.initials: AP
authors.lastname: Rodriguez
authors.affiliation: Cardiovascular Division, Cleveland Clinic, Ohio.
authors.forename: Badal
authors.initials: B
authors.lastname: Thakkar
authors.affiliation: Prince George's Hospital Centre, Cheverly, Md.
authors.forename: Ghanshyambhai T
authors.initials: GT
authors.lastname: Savani
authors.affiliation: Cardiovascular Division, University of Miami Miller School of Medicine, Fla.
authors.forename: Nileshkumar J
authors.initials: NJ
authors.lastname: Patel
authors.affiliation: Cardiovascular Division, The Everett Clinic, Wash.
authors.forename: Apurva O
authors.initials: AO
authors.lastname: Badheka
authors.affiliation: Cardiovascular Division, University of Miami Miller School of Medicine, Fla.
authors.forename: Mauricio G
authors.initials: MG
authors.lastname: Cohen
authors.affiliation: Cardiovascular Division, University of Miami Miller School of Medicine, Fla.
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Alfonso
authors.affiliation: Cardiovascular Division, University of Miami Miller School of Medicine, Fla.
authors.forename: Raul D
authors.initials: RD
authors.lastname: Mitrani
authors.affiliation: Cardiovascular Division, University of Miami Miller School of Medicine, Fla.
authors.forename: Juan
authors.initials: J
authors.lastname: Viles-Gonzalez
authors.affiliation: Cardiovascular Division, University of Miami Miller School of Medicine, Fla.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Goldberger
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000628:therapy; D002637:Chest Pain / Q000209:etiology* / Q000628:therapy; D019970:Cocaine-Related Disorders / Q000150:complications*; D017281:Cost of Illness; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000628:therapy; D062645:Percutaneous Coronary Intervention; D012307:Risk Factors; D014029:Tobacco Use Disorder / Q000150:complications; D055815:Young Adult
keywords: Chest pain; Cocaine use; Mortality; Myocardial infarction; Percutaneous coronary intervention