Cocaine-associated Chest Pain Research Articles

Application of European Society of Cardiology guidelines for evaluating acute coronary syndrome risk in low-risk patients with cocaine-associated chest pain: Findings from the RISK study – An observational analysis

BackgroundCocaine was the drug of choice in 4.7 % of all recreational drug-related emergency department visits. Of these patients, 40 % present with cocaine-associated chest pain, of whom 4.7 % develop an acute coronary syndrome. The American Heart Association recommends a 12-hour observation period for these patients. ObjectiveThis study primarily aimed to ascertain whether the European Society of Cardiology non-ST-elevation myocardial infarction guidelines can be safely applied to rule-out acute coronary syndrome in low-risk patients with cocaine-associated chest pain. MethodsFor this prospective observational cohort study, patients, aged 18–45 years old, who presented with cocaine-associated chest pain and were risk stratified as low risk according to the European Society of Cardiology non-ST-elevation myocardial infarction guidelines and therefore discharged home without prolonged observation period, were included. They were followed to assess major adverse cardiac events four weeks after presentation to the emergency department or chest pain unit. Cocaine use was confirmed with urine toxicology screening. ResultsA total of 107 patients were included and analysed. The accuracy of the self-reported history of recent cocaine use was 94 %. Post-discharge cocaine use persisted among 32 % of patients. None of the included 107 patients died and major adverse cardiac event within four weeks did not occur among 97 patients with available data regarding MACE. ConclusionRuling out an acute coronary syndrome using the European Society of Cardiology non-ST-elevation myocardial infarction guidelines is likely to be safe for patients with cocaine-associated chest pain, however this study was underpowered to reach definitive conclusions.

P05-03: Outcomes in patients with cocaine-associated chest pain admitted to the emergency department: a single centre experience

P05-03: Outcomes in patients with cocaine-associated chest pain admitted to the emergency department: a single centre experience

In patients presenting with cocaine-associated chest pain, does the use of beta-blockers compared with non–beta-blocker agents cause an increased risk of death?

Rahman, Habibur PharmD; Rizkalla, Joseph PharmD; Taylor, Alexandria PharmD, BCPS; Haugh, Amy MLS; Frazier, Winfred MD, MPH, FAAFP Author Information

Acute Cardiovascular Toxicity of Cocaine.

Cocaine is one of the most commonly abused drugs and represents a major public health concern. Cocaine users frequently present to the emergency department, with chest pain being the most common presenting complaint. The incidence of acute myocardial infarction in patients with cocaine-associated chest pain is often quoted as 6%, but it is highly variable depending on the included population. Risk assessment can be challenging in these patients; serial assessment of electrocardiograms and troponins is often required. This review focuses on the assessment and management of patients presenting with cocaine-associated chest pain and cardiotoxicity. Specific treatments are discussed, including benzodiazepines, nitroglycerin, calcium channel blockers, and phentolamine, and how treatment priorities differ from patients with noncocaine presentations. The use of beta-blockers in this population remains controversial, and the literature around its use is reviewed. The most recent literature and recommendations for the use of percutaneous coronary intervention and fibrinolytics in cocaine-associated myocardial infarction is discussed as well. Cocaine-associated dysrhythmias are suggested to be the cause of sudden cardiac death in some users. The pathophysiology and evidence-based treatments for dysrhythmias are reviewed. This review provides evidence-based recommendations for the assessment and management of patients presenting with cocaine-associated cardiovascular toxicity.

Prevalence of myocardial infarction among patients with chest pain and cocaine use: A systematic review and meta-analysis.

Cocaine abuse is a public health burden. Cocaine is known to cause vasospasm and acute myocardial infarction (AMI). The prevalence of AMI in patients presenting with chest pain and concurrent cocaine use (CPCC) varies among studies. We performed a systemic review and meta-analysis to assess the current literature for the prevalence of AMI in patients with CPCC. We performed a literature search of PubMed, EMBASE, and Scopus from its beginning to May 18, 2020 and updated this search on February 18, 2021. Full-text studies that assessed the primary outcome (AMI) specifically among patients with CPCC who presented to the emergency department (ED) were included. We excluded studies that were not in English, did not take place in the ED, and case reports, which only reported positive cases and not incidence of AMI. Random effect meta-analysis was performed to assess the prevalence of primary outcome and to examine correlations between risk factors and AMI. Heterogeneity was assessed by I-square value. We also performed subgroup analysis to identify potential sources of heterogeneity. We identified 2178 studies and screened 102 full-text studies to include 16 studies (3269 patients) in our final analysis. The pooled prevalence of AMI was 4.7% (95% CI 0.8-23), I-square of 84%. However, rates among studies of low risk patients were lower (1.1% 95% CI 0.2-5) compared to studies of mixed risk patients (7.7%, 95% 5-11). A meta-regression was used to look at correlation between risk factors and AMI and found that AMI was positively correlated in patients with a history of CAD (correlation coefficient [Corr. Coeff.] 5.6, 96% CI 2.3-8.7), HTN (Corr. Coeff. 2.9, 95% CI 0.9-4.9), DM (Corr. Coeff. 8.0, 95% CI 2.4-14), HLD (Corr. Coeff. 5.9, 95% CI 2.4, 9). Sources of potential heterogeneity included patients' risk as defined by the authors, study designs, publication year, and study sample size. The overall prevalence of AMI and death among patients with cocaine-associated chest pain was relatively low, although high risk patients were still associated with high prevalence of AMI. Clinicians should consider risk-stratify these patients and treat them accordingly.

THE MONEY IS IN THE AIRWAY: AN ATYPICAL CASE OF NON-CARDIAC CHEST PAIN

TOPIC: Signs and Symptoms of Chest Diseases TYPE: Fellow Case Reports INTRODUCTION: Foreign body aspiration is a common pathology in pediatric medicine but relatively infrequent in the adult population. Symptoms are usually those of acute airway irritation, including cough, dyspnea, and asphyxiation. Acute chest pain is an uncommon manifestation of foreign body aspiration and one that may be overlooked if history suggests another leading diagnosis. It is critical to avoid such a confounding bias, as anchoring can lead to adverse patient outcomes. CASE PRESENTATION: A 58-year-old man with diabetes mellitus, hypertension, coronary artery disease, and a history of substance abuse presented to the emergency department (ED) complaining of chest pain. He described a mid-chest pain that started after consuming cocaine. The pain was non-radiating but associated with mild shortness of breath. In the ED, he was tachycardic, hypertensive, and with normal saturation at room air. His EKG showed sinus tachycardia, and the laboratory workup was unremarkable. Chest X-Ray (fig.1) showed a round metallic density over the left mid lung. Chest CT scan (fig.2 and 3) showed a hyperattenuating foreign body within the left mainstem bronchus. He underwent a bronchoscopy in the operating room, and a dime was retrieved from the left mainstem bronchus with forceps. He tolerated the procedure well with no complications or airway injury and discharged home in stable condition. DISCUSSION: Despite the unusual times we have been going through due to the COVID-19 pandemic, ischemic heart disease remained the leading cause of death in the United States during 2020(1). It is well established that the abuse of illicit substances such as cocaine could lead to myocardial ischemia and infarction (2). Thus, it is a top differential diagnosis when a patient arrives in the ED with chest pain after cocaine use.It is well documented how premature closure and anchoring bias could negatively impact clinical outcomes (3,4,5). Hence, a thorough history and differential diagnosis are paramount to guide the workup and management. Cases of foreign body aspiration in adults often happen in the setting of altered mental status (6) or acute intoxication where patients rarely recall further details leading to their onset of symptoms. Still, the typical presentation includes cough and dyspnea (7) rather than chest pain.In a case of patient-reported recent cocaine use with subsequent chest pain, anchoring to a cocaine-induced chest pain diagnosis is at first understandable. It was the chest pain diagnostic workup that included a chest x-ray that found the cause that was not initially suspected. CONCLUSIONS: We present an interesting case of a dime aspiration lodging the left mainstem bronchus, who presented with chest pain after consuming cocaine. The lack of classic respiratory symptoms and the recent intoxication could have led to anchoring bias where the foreign body aspiration might have been overlooked. REFERENCE #1: 1. Ahmad FB, Cisewski JA, Minino A et al. Provisional Mortality Data – United States, 2020. MMWR Morb Mortal Wkly Rep 2021;70:519-522. REFERENCE #2: 2. McCord J, Jneid H, Hollander JE et al. Management of Cocaine-associated chest pain and myocardial infarction. Circulation. 2008;117:1897–1907. REFERENCE #3: 3. Khadilkar, S.V., Khadilkar, S.S. Bias in Clinical Practice. J Obstet Gynecol India 2020. 70, 1–5. https://doi.org/10.1007/s13224-019-01304-5 4. Makary MA, Daniel M. Medical error – the third leading cause of death in the US BMJ 2016;353:I2139 doi:10.1136/bmj.i2139 5. Saposnik, G., Redelmeier, D., Ruff, C. et al. Cognitive biases associated with medical decisions: a systematic review. BMC medical informatics and decision making, 2016(1), 138. https://doi.org/10.1186/s12911-016-0377-16. Ozdemir et al. Foreign Body Aspiration in Adult. Eurasian J Pulmonol 2015;17: 29-34 7. Bajaj et al. Foreign Body aspiration. J Thorac Dis 2020. doi: 10.21037/jtd.2020.03.94 DISCLOSURES: No relevant relationships by Israel Acosta Sanchez, source=Web Respons No relevant relationships by Tirsa Ferrer Marrero, source=Web Response No relevant relationships by Ray Urban, source=Web Response

Risk and Protective Factors of Lifetime Cocaine-Associated Chest Pain.

Introduction: Cocaine users often present with repetitive events of cocaine-associated chest pain (CACP), clinically resembling acute coronary syndromes. The aim of the study is to describe the specific risk factors for CACP.Method: Cocaine users (n = 316) were recruited for a multicenter cross-sectional study. Lifetime CACP history, sociodemographic factors, and lifetime use of cocaine and other substances were assessed. Thirty single nucleotide polymorphisms (SNPs) of NOS3, ROCK2, EDN1, GUCY1A3, and ALDH2 genes, suggested by the literature on coronary spasms, were selected. The associations with CACP history were tested using the chi-square test, Student's t-test and logistic regression.Results: Among the 316 subjects [78.5% men, mean age 37.5 years, (standard-deviation ±8.7)], 190 (60.1%) were daily cocaine users and 103 (32.6%) reported a lifetime CACP history. Among those with a lifetime CACP history, the median was 10 events per individual. In multivariate analysis, lifetime CACP history was associated with daily cocaine use [odds-ratio (OR) 3.24; 95% confidence intervals (1.29–9.33)], rapid route of cocaine use [OR 2.33 (1.20–4.64) vs. intranasal use], and lifetime amphetamine use [daily amphetamine use: OR 2.80 (1.25–6.32) and non-daily amphetamine use: OR 2.14 (1.15–4.04) vs. never used]. Patients with lifetime opioid maintenance treatment (OMT) reported significantly less lifetime CACP history [OR 0.35 (0.16–0.76)]. None of the selected SNPs was associated with CACP history after multiple testing corrections.Conclusions: Clinical variables describing the intensity of stimulant use were positively associated with lifetime CACP history, while OMT was negatively associated with it. Specific harm reduction strategies can target these risk factors.

Cocaine induced heart failure: report and literature review

ABSTRACT Heart failure is a complex clinical syndrome associated with high mortality and morbidity, creating a major public healthcare problem. It has a variety of etiologies, including substance abuse. Cocaine-induced cardiotoxicity is caused by direct effects of inhibition of sodium channels and indirect effects by inhibiting catecholamine uptake leading to increased sympathetic activity. Management is through the cessation of cocaine use and implantation of guideline-directed medical therapy for heart failure with the exception of beta-blockers as their safe usage is still controversial due to the risk of the unopposed alpha-adrenergic activity. Dexmedetomidine (Precedex) and Benzodiazepines (i.e., midazolam) are options for patients that demonstrate signs and symptoms of acute cocaine intoxication. If the actions of benzodiazepines fail to achieve hemodynamic stability, nitroglycerin may be used (especially in patients with cocaine-associated chest pain and hypertension). Cardiac transplantation is recommended for those who have demonstrated severe cardiovascular disease from cocaine. We present a 43-year-old male with a long-standing history of cocaine use who developed cardiomyopathy and severe acute decompensated heart failure found to have an ejection fraction of <20% admitted to the intensive care unit. He required inotropic support with milrinone and mechanical ventilation. He was later extubated and then discharged with an outpatient evaluation for a cardiac transplant.

The current practice for cocaine-associated chest pain in the Netherlands.

Cocaine is considered a cardiovascular risk factor, yet it is not included in the frequently used risk stratification scores. Moreover, many guidelines provide limited advice on how to diagnose and treat cocaine-associated chest pain (CACP). This study aimed to determine the current practice for CACP patients in emergency departments and coronary care units throughout the Netherlands. An anonymous online questionnaire-based survey was conducted among Dutch emergency physicians and cardiologists between July 2015 and February 2016. The questionnaire was based on the American Heart Association CACP treatment algorithm. A total of 214 subjects were enrolled and completed the questionnaire. All responders considered cocaine use a risk factor for developing acute coronary syndrome (ACS), nevertheless 74.4 % of emergency physicians and 81.1 % of cardiologists do not always question chest pain patients about drug use. Of all responders, 73.6 % never perform toxicology screening. Most responders (60 %) observe patients with CACP according to the European Society of Cardiology ACS guideline, and 24.3 % give these patients ß-blockers. The current practice for CACP patients in most emergency departments and coronary care units in the Netherlands is not in line with the AHA scientific statement. Emergency physicians and cardiologists should be advised to routinely question all chest pain patients on drug history and be aware that the risk stratifications scores are not validated for CACP. Despite the AHA scientific statement of 2008, many respondents utilize ß-blockers for CACP patients, which is supported by published evidence since the statement appeared.

The prognostic value of HEART score in patients with cocaine associated chest pain: An age-and-sex matched cohort study.

HEART score is widely used to stratify patients with chest pain in the emergency department but has never been validated for cocaine-associated chest pain (CACP). We sought to evaluate the performance of HEART score in risk stratifying patients with CACP compared to an age- and sex-matched cohort with non-CACP. The parent study was an observational cohort study that enrolled consecutive patients with chest pain. We identified patients with CACP and age/sex matched them to patients with non-CACP in 1:2 fashion. HEART score was calculated retrospectively from charts. The primary outcome was major adverse cardiac events (MACE) within 30days of indexed encounter. We included 156 patients with CACP and 312 age-and sex-matched patients with non-CACP (n=468, mean age 51±9, 22% females). There was no difference in rate of MACE between the groups (17.9% vs. 15.7%, p=0.54). Compared to the non-CACP group, the HEART score had lower classification performance in those with CACP (AUC=0.68 [0.56-0.80] vs. 0.84 [0.78-0.90], p=0.022). In CACP group, Troponin score had the highest discriminatory value (AUC=0.72 [0.60-0.85]) and Risk factors score had the lowest (AUC=0.47 [0.34-0.59]). In patients deemed low-risk by the HEART score, those with CACP were more likely to experience MACE (14% vs. 4%, OR=3.7 [1.3-10.7], p=0.016). In patients with CACP, HEART score performs poorly in stratifying risk and is not recommended as a rule out tool to identify those at low risk of MACE.

In-Hospital and Long-Term Outcomes of Beta-Blocker Treatment in Cocaine Users: A Systematic Review and Meta-analysis.

BackgroundAlthough β-blocker treatment is generally contraindicated in patients presenting with acute cocaine intoxication due to concern for unopposed α-receptor stimulation, some studies have reported that β-blocker treatment did not increase adverse events in these patients. As this treatment is still controversial, we performed a meta-analysis of observational studies on this topic.MethodsBy searching three electronic databases (MEDLINE, EMBASE, and the Cochrane Library) from their inception to June 11, 2018, we identified eight observational studies with 2,048 patients who presented to hospital with cocaine-associated chest pain or after recent cocaine use. Outcomes of interest were myocardial necrosis or infarction (MI) and death during hospital stay or follow-up. Pooled relative risks (RRs) with 95% confidence intervals (CIs) were calculated by using a random-effects meta-analysis based on the DerSimonian-Laird method.ResultsAmong patients presenting with cocaine-associated chest pain or recent cocaine use, there was no significant difference in in-hospital all-cause mortality (RR, 0.59; 95% CI, 0.24 - 1.47) and MI (RR, 1.24; 95% CI, 0.74 - 2.06) between patients who did and did not receive β-blocker treatment during their hospital stay. During long-term follow-up (mean 2.6 years), there was no significant difference in all-cause mortality (RR, 0.79; 95% CI, 0.44 - 1.41) and MI (RR, 0.96; 95% CI, 0.40 - 2.33) between the two groups.ConclusionsThese results suggest that β-blocker treatment in patients presenting with cocaine intoxication may not be as harmful as originally believed. Further clinical studies are needed to investigate this topic.

Clinical Outcomes After Treatment of Cocaine-Induced Chest Pain with Beta-Blockers: A Systematic Review and Meta-Analysis

BackgroundRecent guidelines have suggested avoiding beta-blockers in the setting of cocaine-associated acute coronary syndrome. However, the available evidence is both scarce and conflicted. The purpose of this systematic review and meta-analysis is to investigate the evidence pertaining to the use of beta-blockers in the setting of acute cocaine-related chest pain and its implication on clinical outcomes. MethodsElectronic databases were systematically searched to identify literature relevant to patients with cocaine-associated chest pain who were treated with or without beta-blockers. We examined the end-points of in-hospital all-cause mortality and myocardial infarction. Pooled risk ratios (RR) and their 95% confidence intervals (CI) were calculated for all outcomes using a random-effects model. ResultsFive studies with a total of 1447 patients were included. Our analyses found no differences between patients treated with or without beta-blockers for either myocardial infarction (RR 1.08; 95% CI, 0.61-1.91) or all-cause mortality (RR 0.75; 95% CI, 0.46-1.24). Heterogeneity among included studies was low to moderate. ConclusionThis systematic review and meta-analysis suggests that beta-blocker use is not associated with adverse clinical outcomes in patients presenting with acute chest pain related to cocaine use.

Abstract 17208: Trends in Hospitalizations Due to Cocaine-Induced Acute Myocardial Infarction: Results From National Inpatient Sample, 2005-2014

Introduction: According to the National Institute on Drug Abuse, lifetime cocaine use has remained stable since 2009. An estimated 1.5 million individuals aged ≥12 years reported cocaine use in 2014. Cocaine use is a significant risk factor for acute myocardial infarction (AMI), especially in the age group 18-45 years. Hence, we examined trends in hospitalizations due to cocaine-induced AMI in the United States. Methods: The current study was a retrospective analysis of the National Inpatient Sample, collected during the period 2005-2014. Participants between 18 and 45 years were included in the analysis. Cocaine-induced AMI hospitalizations were identified using ICD-9-CM codes 304.2X and 305.6X for cocaine dependence or abuse, and 410.XX for AMI diagnosis. We used Cochran Armitage test for categorical variables and Cuzick nonparametric test for trends for continuous variables. Results: A total of 49,715 weighted cocaine-induced AMI hospitalizations were reported during the study period. Cocaine-induced AMI hospitalizations increased from 4,619 in 2005 to 5,065 in 2014 (relative increase, 9.7%, P trend =0.124). Majority of the patients were non-White (55.3%), men (79.3%), in the age group 41-45 years (83.1%), and with Medicare/Medicaid coverage (51.2%). Highest change in trend was observed for non-White population and Medicare/Medicaid payers. Conclusion: Our study showed that cocaine-induced AMI hospitalizations remained stable during the years 2005-2014. Initial results point towards structural and racial disparities in such hospitalizations, especially among non-White men and population with Medicare/Medicaid coverage. Effective interventions to reduce cocaine use are needed, and treatment must be based on 2008 AHA guidelines for cocaine-associated chest pain and myocardial infarction.

Importance of a Risk Stratification Strategy to Identify High-risk Patients Presenting With Cocaine-associated Acute Coronary Syndrome.

Current guidelines recommend treating patients with cocaine-associated chest pain, unstable angina, or myocardial infarction similarly to patients with traditional acute coronary syndrome (ACS). Risk stratifying these patients could potentially reduce unnecessary procedures and improve resource utilization. This is a retrospective cross-sectional analysis of 258 patients presenting with cocaine-associated ACS who underwent cardiac catheterization in a community teaching hospital between 2006 and 2015. The primary outcome was the prevalence of acute obstructive coronary artery disease (CAD) requiring percutaneous coronary intervention and coronary artery bypass grafting compared with that of patients with normal coronary or nonobstructive disease. Of the studied population, 36% had obstructive CAD requiring intervention and 64% were found to have normal coronaries or nonobstructive disease. Significant risk factors for obstructive CAD were older age, history of CAD, diabetes mellitus, dyslipidemia, ST-segment-elevation myocardial infarction, and troponin elevation. A logistic model was developed based on these variables, applied to the studied population, and was found to have 93% sensitivity in predicting the likelihood of obstructive CAD. Cardiac catheterization in patients presenting with cocaine-associated ACS may be overutilized. A predictive model based on clinical risk factors may help individualize patient care and reduce unnecessary invasive diagnostic interventions.

Outcomes of beta blocker use in cocaine-associated chest pain: a meta-analysis

ObjectivesBeta blockers (β-blockers) remain a standard therapy in the early treatment of acute coronary syndromes. However, β-blocker therapy in patients with cocaine-associated chest pain (CACP) continues to be an area...

Early use of beta blockers in patients with cocaine associated chest pain

BackgroundThe most common symptom of cocaine abuse is chest pain. Cocaine induced chest pain (CICP) shares patho-physiological pathways with the acute coronary syndromes (ACS). A key event is the increase of activity of the adrenergic system. Beta blockers (BBs), a cornerstone in the treatment of ACS, are felt to be contraindicated in the patient with CICP due to a potential of an “unopposed alpha adrenergic effect (UAE)”. ObjectivesIdentify signs of UAE and in-hospital complications in patients who received BB while having cocaine induced chest pain. MethodsWe performed a retrospective review of 378 patients admitted to a medical unit because of CICP. Twenty six of these were given a BB at the time of admission while having CICP. We compared these patients to a control group paired by age, sex, race and history of hypertension who did not received a BB while having CICP. Blood pressure, heart rate, length of stay and in-hospital cardiovascular complications were compared. ResultsNo statistically significant differences were found between the two groups except for a longer length of stay in the case group. This was felt to be due to unrelated causes. ConclusionsThis study does not support the presence of an UAE in patients with continuing CICP and treated early with BB. There were no in-hospital cardiovascular complications in the group of patients who had an early dose of BB while having CICP. ImplicationsBB appeared safe when given early on admission to patients with CICP.

Cocaine use does not affect mean platelet volume.

Increased mean platelet volume (MPV) is a marker of platelet activation. Platelet activation with cocaine use is not well studied. We wanted to investigate MPV levels in patients with cocaine-associated chest pain (CACP) as a marker of platelet activation. Retrospectively, MPV of 82 consecutive patients with CACP (group 1) with positive urine drug screen (UDS), without acute myocardial infarction (AMI) (group 1A) and with AMI with elevated troponin (group 1B), were included in the study. The control group (group 2) consisted of 89 consecutive patients admitted during the same time period with acute chest pain (ACP) who had negative UDS and negative cardiac markers with a normal cardiac stress test or normal coronary angiogram. Analysis showed no statistically significant difference of MPV between group 1, 8.46 ± 1.06 fL, versus group 2, 8.7 ± 1.07 fL; p = 0.142; and between group 1A, 8.46 ± 1.05 fL, and group 1B, 8.46 ± 1.09 fL; p = 0.983. By multiple linear regression analysis, MPV was not influenced by cocaine abuse (R = 0.269, R (2) = 0.072, adjusted R (2) = -0.009, p = 0.562). MPV is not elevated in patients with cocaine use even when they had AMI. Further studies may be necessary to investigate the role of platelet activation in patients with cocaine use and chest pain.

Comparison of In-Hospital Outcomes for Beta-Blocker Use Versus Non–Beta Blocker Use in Patients Presenting With Cocaine-Associated Chest Pain

Beta blockers are indicated for management of acute coronary syndromes, but they generally are withheld in patients with cocaine-associated chest pain because of concerns for adverse outcomes related to the unique physiological effects of cocaine. Because few clinical studies have evaluated this interaction, we identified patients with toxicology screen results positive for cocaine treated for chest pain at 2 academic hospitals. Clinical characteristics and in-hospital outcomes were compared between patients with and without β-blocker therapy. We then constructed propensity scores to evaluate the independent relation between β-blocker use and the composite primary end point of myocardial infarction, stroke, ventricular arrhythmia, or all-cause mortality after adjusting for clinical characteristics. Of 376 consecutive patients with cocaine-related chest pain, β blockers were used in 164 (44%). Compared with no β blockers, patients treated with β blockers were more likely to describe anginal chest pain, to have known cardiovascular risk factors, and to receive other antiatherosclerotic therapies. Despite these higher risk clinical characteristics, patients treated with β blockers experienced similar peak troponin levels, individual adverse events, and rates of the composite primary end point (15.9% vs 12.3%, p = 0.32). The primary end point also was similar after propensity score analysis (odds ratio 1.37, 95% confidence interval 0.64 to 2.93, p = 0.42), including specific comparisons of beta-1 selective (odds ratio 1.83, 95% confidence interval 0.79 to 4.24) and nonselective (odds ratio 0.90, 95% confidence interval 0.33 to 2.42) β blockers, when compared with patients not receiving β blockers. In conclusion, no differences in outcomes were observed between patients treated versus not treated with β-blocker therapy in the setting of cocaine-related chest pain.

Transient Cocaine-Induced Chest Pain

Acute chest pain and myocardial infarction are frequent complications of cocaine use. Indeed, these represent 40% of emergency department visits associated with cocaine use and 2% to 7% of all patients attending the emergency department for chest pain. Nevertheless, the prevalence of past cocaine-associated chest pain has never been evaluated in an outpatient facility for addiction. Our objective was to assess lifetime episodes of cocaine-associated chest pain in current cocaine users in an outpatient facility. Fifty consecutive, nonselected current cocaine users were retrospectively evaluated with a standardized interview and a medical assessment. The patients and the pain characteristics are described, and clinical and biological factors associated with experiencing cocaine-associated chest pain are studied with univariate and logistic regressions analyses. Twenty-six subjects (52%) reported a history of chest pain associated with cocaine use. This pain was frequently described as oppressive (28%) and located in the retrosternal area (61.5%). The mean (±SD) time between cocaine use and the occurrence of the pain was 8 (±8) minutes and the mean duration was 22 (±236) minutes. Subjects who reported cocaine-associated chest pain reported an average of 12 (±7) distinct episodes. Patients describing chest pain could be predicted with one independent factor in our sample: age of onset of cocaine use (P = 0.042). Transient cocaine-associated chest pains are frequent in current cocaine users attending specialized addiction facilities. Cardiological explorations and monitoring and risk-reduction interventions need to be provided to this specific population.

CRT-148 TIMI Risk Score Can Be Used for Choosing Treatment Strategy in Patients with Cocaine Associated Chest Pain

To determine value of TIMI risk score in evaluation of patients admitted with cocaine associated chest pain (CACP). It has been shown that in patients with unstable angina/Non-ST Elevation myocardial infarction (NSTEMI), the TIMI risk score categorizes a patient’s risk of death, ischemic events