Evaluation of patients with methamphetamine- and cocaine-related chest pain in a chest pain observation unit

OBJECTIVE: Risk of acute coronary events in patients with methamphetamine and cocaine intoxication has been described. Little is known about the need for additional evaluation in these patients who do not have evidence of myocardial infarction after the initial emergency department evaluation. We herein describe our experience with these patients in a chest pain unit (CPU) and the rate of cardiac-related chest pain in this group. METHODS: Retrospective analysis of patients evaluated in our CPU from January 1, 2000 to December 16, 2004 with a history of chest pain. Patients who had a positive urine toxicologic screen for methamphetamine or cocaine were included. No patients had ECG or cardiac injury marker evidence of myocardial infarction or ischemia during the initial emergency department evaluation. A diagnosis of cardiac-related chest pain was based upon positive diagnostic testing (exercise stress testing, nuclear perfusion imaging, stress echocardiography, or coronary artery stenosis >70%). RESULTS: During the study period, 4568 patients were evaluated in the CPU. A total of 1690 (37%) of patients admitted to the CPU underwent urine toxicologic testing. The result of urine toxicologic test was positive for cocaine or methamphetamine in 224 (5%). In the 2871 patients who underwent diagnostic testing for coronary artery disease (CAD), 401 (14%) were found to have positive results. There was no difference in the prevalence of CAD between those with positive result for toxicology screens (26/156, 17%) and those without (375/2715, 13%, RR 1.2, 95% CI 0.8-1.7). CONCLUSION: These findings suggest a relatively high rate of CAD in patients with methamphetamine and cocaine use evaluated in a CPU.