Prospective Multicenter Evaluation of Cocaine‐associated Chest Pain

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

207 Scopus citations

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
Volume1
Issue number4
DOIs
StatePublished - Jul 1994

Keywords

  • ECG
  • angina
  • cocaine
  • drug abuse
  • ischemia
  • myocardial infarction

ASJC Scopus subject areas

  • Emergency Medicine

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    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. (1994). Prospective Multicenter Evaluation of Cocaine‐associated Chest Pain. Academic Emergency Medicine, 1(4), 330-339. https://doi.org/10.1111/j.1553-2712.1994.tb02639.x