Article Text

  1. R Sharma1,
  2. E Garg1,
  3. D Conaway2,
  4. M Garg3
  1. 1Kansas City University of Medicine and Biosciences, Kansas City, MO, United States
  2. 2University of Missouri Kansas City, Kansas City, MO, United States
  3. 3Nebraska Heart Institute, Hastings, MO, United States


    Purpose of Study Cocaine-related chest discomfort is frequently encountered in urban emergency departments. Incidence of co-morbid illness and heart disease is not well defined in patients with cocaine-related ACS. Appropriate risk stratification in patients with cocaine-related ACS is not clearly defined.

    Methods Used 231 consecutive patients meeting inclusion criteria were entered into a large ACS registry at an urban, inner-city acute-care facility. Comparisons in demographics, co-morbid conditions, left ventricular function and coronary disease were made between patients with cocaine-related ACS and those with non-cocaine ACS.

    Summary of Results 44 (19%) of these patients either tested positive for cocaine by urine drug screen or had self-reported cocaine abuse. Compared to the non-cocaine ACS patients, these individuals were significantly younger, more likely to be male, unmarried, uninsured and also have history of alcohol and tobacco abuse (all p<0.05). The cocaine-users were less likely to have risk factors of diabetes (p<0.002) and hyperlipidemia (p<0.02). Ejection fraction mean was 51.3% (sd 15.4) in the cocaine-users vs. 48.1% (sd 14.0) in the non-cocaine users, with an incidence of EF</=40% of 28% vs. 31% respectively (p=ns). 50% (22/44) of the cocaine-users underwent a stress test evaluation, and 27% of these were positive for ischemia. Of the 41% (18/44) undergoing cardiac catheterization, 13/18 were diagnosed with significant CAD, 4/18 with non-ischemic cardiomyopathy, and one study was normal. A total of 24/44 (55%) had either a new or old diagnosis of documented CAD or NICM, compared to 94% of the non-cocaine ACS patients.

    Conclusions Cocaine-related chest pain leading to hospitalization is often associated with infarction or significant coronary artery disease. Although optimal evidence-based management is lacking in this population, ischemia evaluations and appropriate further risk stratification and modification may be warranted.

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