Cocaine-associated myocardial infarction: Clinical safety of thrombolytic therapy

J. E. Hollander, J. L. Burstein, R. S. Hoffman, R. D. Shih, L. D. Wilson, J. Bartfield, N. Raccio-Robak, F. Harchelroad, L. Nelson, M. Sandoval, J. Feldman, S. Fish, R. Paynter, C. Whelan, R. Silverman, K. Scheppke, H. Thomaser, S. Doyon, P. Wax

Research output: Contribution to journalArticle

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Abstract

Objective: To determine the safety of thrombolytic use in patients with cocaine-associated myocardial infarction. Design: Retrospective cross- sectional survey. Setting: Twenty-nine acute care institutions. Patients: Patients who sustained cocaine-associated myocardial infarction from 1987 to 1993 were identified through medical record review. Those who received thrombolytic therapy (n=25) were compared with those who met electrocardiographic TIMI criteria but did not receive thrombolytic therapy (n=41). Interventions: None. Results: Both groups of patients were similar with respect to age, gender, race, cardiac risk factors, time from last cocaine use until presentation, and duration of chest pain at the time of presentation (p>0.20). There were no major complications or deaths in patients who received thrombolytic therapy (95% confidence interval, 0 to 12%). Minor complications occurred in only two patients. The presence or absence of clinical criteria for reperfusion was noted in the charts of 21 patients who received thrombolytic therapy: 67% were believed to reperfuse. The patients who did and did not receive thrombolytic therapy had similar median peak creatine kinase-MR (CK-MB) levels (180 vs 154 mg/dL, p=NS) and time until peak CK-MB (11.3 vs 13.6 h; p=NS). Conclusion: Thrombolytic therapy for cocaine-associated myocardial infarction appears to be safe. It remains unclear whether thrombolytic therapy is an important therapeutic intervention for patients with cocaine-associated myocardial infarction. Further study on efficacy is recommended prior to routine use.

Original languageEnglish (US)
Pages (from-to)1237-1241
Number of pages5
JournalChest
Volume107
Issue number5
StatePublished - 1995

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Thrombolytic Therapy
Cocaine
Myocardial Infarction
Safety
Creatine Kinase
Chest Pain
Reperfusion
Medical Records
Cross-Sectional Studies
Confidence Intervals

Keywords

  • cocaine
  • complications
  • mortality
  • myocardial infarction
  • survival
  • thrombolysis

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Hollander, J. E., Burstein, J. L., Hoffman, R. S., Shih, R. D., Wilson, L. D., Bartfield, J., ... Wax, P. (1995). Cocaine-associated myocardial infarction: Clinical safety of thrombolytic therapy. Chest, 107(5), 1237-1241.

Cocaine-associated myocardial infarction : Clinical safety of thrombolytic therapy. / Hollander, J. E.; Burstein, J. L.; Hoffman, R. S.; Shih, R. D.; Wilson, L. D.; Bartfield, J.; Raccio-Robak, N.; Harchelroad, F.; Nelson, L.; Sandoval, M.; Feldman, J.; Fish, S.; Paynter, R.; Whelan, C.; Silverman, R.; Scheppke, K.; Thomaser, H.; Doyon, S.; Wax, P.

In: Chest, Vol. 107, No. 5, 1995, p. 1237-1241.

Research output: Contribution to journalArticle

Hollander, JE, Burstein, JL, Hoffman, RS, Shih, RD, Wilson, LD, Bartfield, J, Raccio-Robak, N, Harchelroad, F, Nelson, L, Sandoval, M, Feldman, J, Fish, S, Paynter, R, Whelan, C, Silverman, R, Scheppke, K, Thomaser, H, Doyon, S & Wax, P 1995, 'Cocaine-associated myocardial infarction: Clinical safety of thrombolytic therapy', Chest, vol. 107, no. 5, pp. 1237-1241.
Hollander JE, Burstein JL, Hoffman RS, Shih RD, Wilson LD, Bartfield J et al. Cocaine-associated myocardial infarction: Clinical safety of thrombolytic therapy. Chest. 1995;107(5):1237-1241.
Hollander, J. E. ; Burstein, J. L. ; Hoffman, R. S. ; Shih, R. D. ; Wilson, L. D. ; Bartfield, J. ; Raccio-Robak, N. ; Harchelroad, F. ; Nelson, L. ; Sandoval, M. ; Feldman, J. ; Fish, S. ; Paynter, R. ; Whelan, C. ; Silverman, R. ; Scheppke, K. ; Thomaser, H. ; Doyon, S. ; Wax, P. / Cocaine-associated myocardial infarction : Clinical safety of thrombolytic therapy. In: Chest. 1995 ; Vol. 107, No. 5. pp. 1237-1241.
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abstract = "Objective: To determine the safety of thrombolytic use in patients with cocaine-associated myocardial infarction. Design: Retrospective cross- sectional survey. Setting: Twenty-nine acute care institutions. Patients: Patients who sustained cocaine-associated myocardial infarction from 1987 to 1993 were identified through medical record review. Those who received thrombolytic therapy (n=25) were compared with those who met electrocardiographic TIMI criteria but did not receive thrombolytic therapy (n=41). Interventions: None. Results: Both groups of patients were similar with respect to age, gender, race, cardiac risk factors, time from last cocaine use until presentation, and duration of chest pain at the time of presentation (p>0.20). There were no major complications or deaths in patients who received thrombolytic therapy (95{\%} confidence interval, 0 to 12{\%}). Minor complications occurred in only two patients. The presence or absence of clinical criteria for reperfusion was noted in the charts of 21 patients who received thrombolytic therapy: 67{\%} were believed to reperfuse. The patients who did and did not receive thrombolytic therapy had similar median peak creatine kinase-MR (CK-MB) levels (180 vs 154 mg/dL, p=NS) and time until peak CK-MB (11.3 vs 13.6 h; p=NS). Conclusion: Thrombolytic therapy for cocaine-associated myocardial infarction appears to be safe. It remains unclear whether thrombolytic therapy is an important therapeutic intervention for patients with cocaine-associated myocardial infarction. Further study on efficacy is recommended prior to routine use.",
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AU - Wilson, L. D.

AU - Bartfield, J.

AU - Raccio-Robak, N.

AU - Harchelroad, F.

AU - Nelson, L.

AU - Sandoval, M.

AU - Feldman, J.

AU - Fish, S.

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AU - Whelan, C.

AU - Silverman, R.

AU - Scheppke, K.

AU - Thomaser, H.

AU - Doyon, S.

AU - Wax, P.

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N2 - Objective: To determine the safety of thrombolytic use in patients with cocaine-associated myocardial infarction. Design: Retrospective cross- sectional survey. Setting: Twenty-nine acute care institutions. Patients: Patients who sustained cocaine-associated myocardial infarction from 1987 to 1993 were identified through medical record review. Those who received thrombolytic therapy (n=25) were compared with those who met electrocardiographic TIMI criteria but did not receive thrombolytic therapy (n=41). Interventions: None. Results: Both groups of patients were similar with respect to age, gender, race, cardiac risk factors, time from last cocaine use until presentation, and duration of chest pain at the time of presentation (p>0.20). There were no major complications or deaths in patients who received thrombolytic therapy (95% confidence interval, 0 to 12%). Minor complications occurred in only two patients. The presence or absence of clinical criteria for reperfusion was noted in the charts of 21 patients who received thrombolytic therapy: 67% were believed to reperfuse. The patients who did and did not receive thrombolytic therapy had similar median peak creatine kinase-MR (CK-MB) levels (180 vs 154 mg/dL, p=NS) and time until peak CK-MB (11.3 vs 13.6 h; p=NS). Conclusion: Thrombolytic therapy for cocaine-associated myocardial infarction appears to be safe. It remains unclear whether thrombolytic therapy is an important therapeutic intervention for patients with cocaine-associated myocardial infarction. Further study on efficacy is recommended prior to routine use.

AB - Objective: To determine the safety of thrombolytic use in patients with cocaine-associated myocardial infarction. Design: Retrospective cross- sectional survey. Setting: Twenty-nine acute care institutions. Patients: Patients who sustained cocaine-associated myocardial infarction from 1987 to 1993 were identified through medical record review. Those who received thrombolytic therapy (n=25) were compared with those who met electrocardiographic TIMI criteria but did not receive thrombolytic therapy (n=41). Interventions: None. Results: Both groups of patients were similar with respect to age, gender, race, cardiac risk factors, time from last cocaine use until presentation, and duration of chest pain at the time of presentation (p>0.20). There were no major complications or deaths in patients who received thrombolytic therapy (95% confidence interval, 0 to 12%). Minor complications occurred in only two patients. The presence or absence of clinical criteria for reperfusion was noted in the charts of 21 patients who received thrombolytic therapy: 67% were believed to reperfuse. The patients who did and did not receive thrombolytic therapy had similar median peak creatine kinase-MR (CK-MB) levels (180 vs 154 mg/dL, p=NS) and time until peak CK-MB (11.3 vs 13.6 h; p=NS). Conclusion: Thrombolytic therapy for cocaine-associated myocardial infarction appears to be safe. It remains unclear whether thrombolytic therapy is an important therapeutic intervention for patients with cocaine-associated myocardial infarction. Further study on efficacy is recommended prior to routine use.

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