Abstract P105: Safety of Beta Blockers in the Acute Management of Cocaine-associated Chest Pain

Abstract

Cocaine is the most abused illegal drug in patients presenting to emergency rooms with chest pain, accounting for almost 40% of all drug related visits. It is not known whether all â Blockers (BB) and α1-Selective agents (α1-BB) or mixed α1/β-adrenergic antagonists (α1/β-BB) are safe in the acute management of cocaine-associated chest pain, due to fears of unopposed alpha-receptor activity resulting in coronary artery spasm and hypertensive urgency. Methods: 378 patients presenting to the emergency rooms (ER) in two different hospitals with chest pain who tested positive for cocaine, were evaluated by retrospective chart review. We reviewed the presence and type of BB used in relation to peak elevation in troponin T and troponin I. Troponin elevation was defined as a troponin I >0.6 and troponin T >0.1 if creatinine was <2 mg/dl. Results: The 378 patients comprised African Americans (77%), Hispanics (11%), Caucasian (9%). Of these 12% had typical chest pain, 22% had history of coronary artery disease, 56% had hypertension, and 21% had diabetes mellitus. The admission EKG showed changes (ST elevation, ST depression or new T wave inversion) in 43%. BBs were used in 43%. Troponin became elevated in 9.9% of all patients. There was no difference in the number of patients with troponin rise in the BB and non-BB groups 21/165 vs 16/213 (p=0.1). There was no difference in mean peak troponin levels in patients with troponin rise who were treated with BB vs. no BB 6.7 vs. 5.7 (p=0.6). There was no difference in mean peak troponin levels in patients with troponin rise who were treated with a β1-BB vs. a α1/β-BB 7.5 vs. 4.1 (p=.4). No cases of hypertensive urgency were identified after taking any BB. Conclusion: Troponin rise is not uncommon in patients with cocaine associated chest pain and occurs in 10%. In patients with cocaine-associated chest pain BBs did not appear to change the incidence of troponin rise. â1 Selective BBs did not appear to worsen troponin levels compared to mixed α1/â-adrenergic antagonists. There were no cases of unopposed alpha activity reported.