Assessment of myocardial infarction by CT angiography and cardiovascular MRI in patients with cocaine-associated chest pain: a pilot study

Paraschin, Karen; Andrade, Arthur Guerra de; Parga, José R.

doi:10.1259/bjr/52001979

Cited by 11 publications

(4 citation statements)

References 26 publications

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“…Despite some controversy [3,53,71], left ventricular hypertrophy (as shown in Fig. 2) is among the most prevalent chronic morphological findings associated with cocaine toxicity in patients with cocaine-associated chest pain [2–4,10,16,24,50,72–77].…”

Section: Chronic Effects Of Cocainementioning

confidence: 99%

Vascular disease in cocaine addiction

et al. 2017

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Cocaine, a powerful vasoconstrictor, induces immune responses including cytokine elevations. Chronic cocaine use is associated with functional brain impairments potentially mediated by vascular pathology. Although the Crack-Cocaine epidemic has declined, its vascular consequences are increasingly becoming evident among individuals with cocaine use disorder of that period, now aging. Paradoxically, during the period when prevention efforts could make a difference, this population receives psychosocial treatment at best. We review major postmortem and in vitro studies documenting cocaine-induced vascular toxicity. PubMed and Academic Search Complete were used with relevant terms. Findings consist of the major mechanisms of cocaine-induced vasoconstriction, endothelial dysfunction, and accelerated atherosclerosis, emphasizing acute, chronic, and secondary effects of cocaine. The etiology underlying cocaine's acute and chronic vascular effects is multifactorial, spanning hypertension, impaired homeostasis and platelet function, thrombosis, thromboembolism, and alterations in blood flow. Early detection of vascular disease in cocaine addiction by multimodality imaging is discussed. Treatment may be similar to indications in patients with traditional risk-factors, with few exceptions such as enhanced supportive care and use of benzodiazepines and phentolamine for sedation, and avoiding β-blockers. Given the vascular toxicity cocaine induces, further compounded by smoking and alcohol comorbidity, and interacting with aging of the crack generation, there is a public health imperative to identify pre-symptomatic markers of vascular impairments in cocaine addiction and employ preventive treatment to reduce silent disease progression.

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Section: Chronic Effects Of Cocainementioning

confidence: 99%

Vascular disease in cocaine addiction

et al. 2017

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“…"Efficacy assessment" study designs attempt to determine the relative balance of benefits versus harms and are often concerned about safety. We identified one "incidence study", described as a "pilot" 10 . Incidence studies are epidemiological designs that measure incidence of an outcome, myocardial infarction in this case, in a population following their exposure 11 .…”

Section: Discussionmentioning

confidence: 99%

Do radiological research articles apply the term “pilot study” correctly? Systematic review

et al. 2020

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“…Paraschin and colleagues applied cardiac CT angiography (CTA) in 24 cocaine users presenting with chest pain. They found that cardiac CTA was normal in 96% of patients, and positive in only 1 patient (4%) who had non-significant coronary stenosis 16. The use of imaging studies and/or provocative testing can expedite patient disposition; however, the risks of contrast allergies, contrast-induced nephropathy, and radiation exposure are all important considerations.…”

Section: Discussionmentioning

confidence: 99%

Impact of an Abbreviated Cardiac Enzyme Protocol to Aid Rapid Discharge of Patients with Cocaine-associated Chest Pain in the Clinical Decision Unit

Guirgis¹,

Gray-Eurom²,

Mayfield³

et al. 2014

WestJEM

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IntroductionIn 2007 there were 64,000 visits to the emergency department (ED) for possible myocardial infarction (MI) related to cocaine use. Prior studies have demonstrated that low- to intermediate-risk patients with cocaine-associated chest pain can be safely discharged after 9–12 hours of observation. The goal of this study was to determine the safety of an 8-hour protocol for ruling out MI in patients who presented with cocaine-associated chest pain.MethodsWe conducted a retrospective review of patients treated with an 8-hour cocaine chest pain protocol between May 1, 2011 and November 30, 2012 who were sent to the clinical decision unit (CDU) for observation. The protocol included serial cardiac biomarker testing with Troponin-T, CK-MB (including delta CK-MB), and total CK at 0, 2, 4, and 8 hours after presentation with cardiac monitoring for the observation period. Patients were followed up for adverse cardiac events or death within 30 days of discharge.ResultsThere were 111 admissions to the CDU for cocaine chest pain during the study period. One patient had a delta CK-MB of 1.6 ng/ml, but had negative Troponin-T at all time points. No patient had a positive Troponin-T or CK-MB at 0, 2, 4 or 8 hours, and there were no MIs or deaths within 30 days of discharge. Most patients were discharged home (103) and there were 8 inpatient admissions from the CDU. Of the admitted patients, 2 had additional stress tests that were negative, 1 had additional cardiac biomarkers that were negative, and all 8 patients were discharged home. The estimated risk of missing MI using our protocol is, with 99% confidence, less than 5.1% and with 95% confidence, less than 3.6% (99% CI, 0–5.1%; 95% CI, 0–3.6%).ConclusionApplication of an abbreviated cardiac enzyme protocol resulted in the safe and rapid discharge of patients presenting to the ED with cocaine-associated chest pain.

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Assessment of myocardial infarction by CT angiography and cardiovascular MRI in patients with cocaine-associated chest pain: a pilot study

Cited by 11 publications

References 26 publications

Vascular disease in cocaine addiction

Vascular disease in cocaine addiction

Do radiological research articles apply the term “pilot study” correctly? Systematic review

Impact of an Abbreviated Cardiac Enzyme Protocol to Aid Rapid Discharge of Patients with Cocaine-associated Chest Pain in the Clinical Decision Unit

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