Negative association between ethanol intoxication and myocardial infarction in patients with chest pain

Abstract

Study objectives: In our experience, ethanol-intoxicated patients with chest pain have a low incidence of acute myocardial infarction (AMI). Our hypothesis is that is negatively associated with AMI in patients with chest pain. All patient data, including chief complaint, emergency department discharge diagnosis, and laboratory studies, are recorded in the Emstat database. At presentation, if nurses suspect intoxication, breath ethanol is measured and recorded in its own field. Methods: This was a retrospective cohort study of patients aged 30 years or older and with a chief complaint or discharge diagnosis of chest pain who also had a breath ethanol level of 0.08% or greater, from January 1, 2000, through October 31, 2002. As a no intoxication control group, we searched the database for all patients aged 30 years or older and with a chief complaint or discharge diagnosis of chest pain during 2001 whose breath ethanol was either not recorded or was less than 0.08%. Patients with a discharge diagnosis of acute coronary syndrome, unstable angina, or AMI whose chief complaint was other than chest pain were not included in either group. Troponin I (TnI) was assayed by Dade Dimension RxL; the normal level is less than 0.1 ng/mL; the diagnostic level is greater than 0.3 ng/mL. All TnI levels, single or serial, were reviewed for all patients. AMI was defined as at least 1 TnI greater than 0.3 ng/mL or at least 1 troponin level of 0.2 or 0.3 ng/mL and a determination by medical record review (including cardiology consultations, ECGs, clinical course, nuclear scanning, provocative testing, and cardiac catheterization) that this troponin elevation was a result of AMI. Rates of AMI between the experimental and control group were compared using χ 2 tests. Results: There were 219 patients in the study group of intoxicated patients with chest pain; 2 (0.9%) of 219 patients had AMI. There were 3,344 patients in the no intoxication control group; 155 (4.64%) patients had AMI ( P =.009). Conclusion: At our institution, among ethanol-intoxicated patients aged 30 years or older with chest pain, compared with nonintoxicated patients, there is a significant negative association with AMI. Prospective investigation is needed to determine whether ethanol in patients who present with chest pain is negatively predictive of AMI.