Prospective multicenter evaluation of cocaine-associated chest pain. Cocaine Associated Chest Pain (COCHPA) Study Group.

J. E. Hollander, R. S. Hoffman, P. Gennis, P. Fairweather, M. J. DiSano, D. A. Schumb, J. A. Feldman, S. S. Fish, S. Dyer, P. Wax

Research output: Contribution to journalArticle

203 Citations (Scopus)

Abstract

OBJECTIVE: To describe a large cohort of patients who had chest pain following cocaine use, and to determine the incidence of and clinical characteristics predictive for myocardial infarction in this group of patients. METHODS: A prospective observational cohort study of consecutive patients with cocaine-associated chest pain was conducted in six municipal hospital emergency departments (EDs). Demographic variables, drug abuse patterns, medical histories, chest pain characteristics, ECG results, and laboratory data were recorded. Myocardial infarction was the primary endpoint. RESULTS: Fourteen of 246 patients (5.7%; 95% confidence interval [CI], 2.7-8.7%) had myocardial infarction, as diagnosed by elevated CK-MB isoenzyme levels. There were two deaths (0.8%). The patients had a median age of 33 years. The majority were male (71.5%), non-white (83.3%), cigarette smokers (83.3%) who used cocaine regularly. Chest pain began a median of 60 minutes after cocaine use and persisted for a median of 120 minutes. Chest pain was most frequently described as substernal (71.3%) and pressure-like (46.7%). Shortness of breath (59.3%) and diaphoresis (38.6%) were common. There was no clinical difference between patients who had myocardial infarctions and those who did not. Twelve patients had arrhythmias and four had congestive heart failure. All cases requiring intervention were evident upon presentation. An ECG revealing ischemia or infarction had a sensitivity of 35.7% for predicting a myocardial infarction. The specificity, positive predictive value, and negative predictive value of the ECGs were 89.9%, 17.9%, and 95.8%, respectively. CONCLUSIONS: Myocardial infarction in patients who have cocaine-associated chest pain is not uncommon. No clinical parameter available to the physician can adequately identify patients at very low risk for myocardial infarction. Therefore, all patients with cocaine-associated chest pain should be evaluated for myocardial infarction.

Original languageEnglish (US)
Pages (from-to)330-339
Number of pages10
JournalAcademic emergency medicine : official journal of the Society for Academic Emergency Medicine
Volume1
Issue number4
StatePublished - Jul 1994

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Chest Pain
Cocaine
Myocardial Infarction
Electrocardiography
Municipal Hospitals
Hospital Departments
Tobacco Products
Dyspnea
Infarction
Isoenzymes
Substance-Related Disorders
Observational Studies
Hospital Emergency Service
Cardiac Arrhythmias
Cohort Studies
Ischemia
Heart Failure
Demography
Confidence Intervals
Physicians

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Prospective multicenter evaluation of cocaine-associated chest pain. Cocaine Associated Chest Pain (COCHPA) Study Group. / Hollander, J. E.; Hoffman, R. S.; Gennis, P.; Fairweather, P.; DiSano, M. J.; Schumb, D. A.; Feldman, J. A.; Fish, S. S.; Dyer, S.; Wax, P.

In: Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, Vol. 1, No. 4, 07.1994, p. 330-339.

Research output: Contribution to journalArticle

Hollander, JE, Hoffman, RS, Gennis, P, Fairweather, P, DiSano, MJ, Schumb, DA, Feldman, JA, Fish, SS, Dyer, S & Wax, P 1994, 'Prospective multicenter evaluation of cocaine-associated chest pain. Cocaine Associated Chest Pain (COCHPA) Study Group.', Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, vol. 1, no. 4, pp. 330-339.
Hollander, J. E. ; Hoffman, R. S. ; Gennis, P. ; Fairweather, P. ; DiSano, M. J. ; Schumb, D. A. ; Feldman, J. A. ; Fish, S. S. ; Dyer, S. ; Wax, P. / Prospective multicenter evaluation of cocaine-associated chest pain. Cocaine Associated Chest Pain (COCHPA) Study Group. In: Academic emergency medicine : official journal of the Society for Academic Emergency Medicine. 1994 ; Vol. 1, No. 4. pp. 330-339.
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title = "Prospective multicenter evaluation of cocaine-associated chest pain. Cocaine Associated Chest Pain (COCHPA) Study Group.",
abstract = "OBJECTIVE: To describe a large cohort of patients who had chest pain following cocaine use, and to determine the incidence of and clinical characteristics predictive for myocardial infarction in this group of patients. METHODS: A prospective observational cohort study of consecutive patients with cocaine-associated chest pain was conducted in six municipal hospital emergency departments (EDs). Demographic variables, drug abuse patterns, medical histories, chest pain characteristics, ECG results, and laboratory data were recorded. Myocardial infarction was the primary endpoint. RESULTS: Fourteen of 246 patients (5.7{\%}; 95{\%} confidence interval [CI], 2.7-8.7{\%}) had myocardial infarction, as diagnosed by elevated CK-MB isoenzyme levels. There were two deaths (0.8{\%}). The patients had a median age of 33 years. The majority were male (71.5{\%}), non-white (83.3{\%}), cigarette smokers (83.3{\%}) who used cocaine regularly. Chest pain began a median of 60 minutes after cocaine use and persisted for a median of 120 minutes. Chest pain was most frequently described as substernal (71.3{\%}) and pressure-like (46.7{\%}). Shortness of breath (59.3{\%}) and diaphoresis (38.6{\%}) were common. There was no clinical difference between patients who had myocardial infarctions and those who did not. Twelve patients had arrhythmias and four had congestive heart failure. All cases requiring intervention were evident upon presentation. An ECG revealing ischemia or infarction had a sensitivity of 35.7{\%} for predicting a myocardial infarction. The specificity, positive predictive value, and negative predictive value of the ECGs were 89.9{\%}, 17.9{\%}, and 95.8{\%}, respectively. CONCLUSIONS: Myocardial infarction in patients who have cocaine-associated chest pain is not uncommon. No clinical parameter available to the physician can adequately identify patients at very low risk for myocardial infarction. Therefore, all patients with cocaine-associated chest pain should be evaluated for myocardial infarction.",
author = "Hollander, {J. E.} and Hoffman, {R. S.} and P. Gennis and P. Fairweather and DiSano, {M. J.} and Schumb, {D. A.} and Feldman, {J. A.} and Fish, {S. S.} and S. Dyer and P. Wax",
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T1 - Prospective multicenter evaluation of cocaine-associated chest pain. Cocaine Associated Chest Pain (COCHPA) Study Group.

AU - Hollander, J. E.

AU - Hoffman, R. S.

AU - Gennis, P.

AU - Fairweather, P.

AU - DiSano, M. J.

AU - Schumb, D. A.

AU - Feldman, J. A.

AU - Fish, S. S.

AU - Dyer, S.

AU - Wax, P.

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N2 - OBJECTIVE: To describe a large cohort of patients who had chest pain following cocaine use, and to determine the incidence of and clinical characteristics predictive for myocardial infarction in this group of patients. METHODS: A prospective observational cohort study of consecutive patients with cocaine-associated chest pain was conducted in six municipal hospital emergency departments (EDs). Demographic variables, drug abuse patterns, medical histories, chest pain characteristics, ECG results, and laboratory data were recorded. Myocardial infarction was the primary endpoint. RESULTS: Fourteen of 246 patients (5.7%; 95% confidence interval [CI], 2.7-8.7%) had myocardial infarction, as diagnosed by elevated CK-MB isoenzyme levels. There were two deaths (0.8%). The patients had a median age of 33 years. The majority were male (71.5%), non-white (83.3%), cigarette smokers (83.3%) who used cocaine regularly. Chest pain began a median of 60 minutes after cocaine use and persisted for a median of 120 minutes. Chest pain was most frequently described as substernal (71.3%) and pressure-like (46.7%). Shortness of breath (59.3%) and diaphoresis (38.6%) were common. There was no clinical difference between patients who had myocardial infarctions and those who did not. Twelve patients had arrhythmias and four had congestive heart failure. All cases requiring intervention were evident upon presentation. An ECG revealing ischemia or infarction had a sensitivity of 35.7% for predicting a myocardial infarction. The specificity, positive predictive value, and negative predictive value of the ECGs were 89.9%, 17.9%, and 95.8%, respectively. CONCLUSIONS: Myocardial infarction in patients who have cocaine-associated chest pain is not uncommon. No clinical parameter available to the physician can adequately identify patients at very low risk for myocardial infarction. Therefore, all patients with cocaine-associated chest pain should be evaluated for myocardial infarction.

AB - OBJECTIVE: To describe a large cohort of patients who had chest pain following cocaine use, and to determine the incidence of and clinical characteristics predictive for myocardial infarction in this group of patients. METHODS: A prospective observational cohort study of consecutive patients with cocaine-associated chest pain was conducted in six municipal hospital emergency departments (EDs). Demographic variables, drug abuse patterns, medical histories, chest pain characteristics, ECG results, and laboratory data were recorded. Myocardial infarction was the primary endpoint. RESULTS: Fourteen of 246 patients (5.7%; 95% confidence interval [CI], 2.7-8.7%) had myocardial infarction, as diagnosed by elevated CK-MB isoenzyme levels. There were two deaths (0.8%). The patients had a median age of 33 years. The majority were male (71.5%), non-white (83.3%), cigarette smokers (83.3%) who used cocaine regularly. Chest pain began a median of 60 minutes after cocaine use and persisted for a median of 120 minutes. Chest pain was most frequently described as substernal (71.3%) and pressure-like (46.7%). Shortness of breath (59.3%) and diaphoresis (38.6%) were common. There was no clinical difference between patients who had myocardial infarctions and those who did not. Twelve patients had arrhythmias and four had congestive heart failure. All cases requiring intervention were evident upon presentation. An ECG revealing ischemia or infarction had a sensitivity of 35.7% for predicting a myocardial infarction. The specificity, positive predictive value, and negative predictive value of the ECGs were 89.9%, 17.9%, and 95.8%, respectively. CONCLUSIONS: Myocardial infarction in patients who have cocaine-associated chest pain is not uncommon. No clinical parameter available to the physician can adequately identify patients at very low risk for myocardial infarction. Therefore, all patients with cocaine-associated chest pain should be evaluated for myocardial infarction.

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