Chest Pain Associated With Cocaine: An Assessment of Prevalence in Suburban and Urban Emergency Departments

Hollander, Judd E.; Todd, Knox H.; Green, Gary; Heilpern, Katherine L.; Karras, David J.; Singer, Adam J.; Brogan, Gerard X.; Funk, Joseph P; Strahan, Judy B

doi:10.1016/s0196-0644(95)70035-8

Cited by 99 publications

(46 citation statements)

References 35 publications

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“…The prevalence of cocaine use is similar to values previously reported 24 and does not compromise generalizability of the study. In summary, these findings support the dual use of CK and troponin testing as an effective technology for evaluating outpatient veterans who present belatedly with symptoms concerning for ACS.…”

supporting

confidence: 87%

The effect of cardiac troponin testing on clinical care in a veterans population

2005

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supporting

confidence: 87%

The effect of cardiac troponin testing on clinical care in a veterans population

2005

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“…5 The proportion of these episodes that are related to cocaine use is difficult to determine 6 ; however, in one study from 1 suburban hospital and 3 urban hospitals, cocaine use was documented in 17% of patients under the age of 60 years who were admitted with chest pain. 7 The evaluation of chest pain after cocaine use is complicated by the unreliability of the ECG for diagnosing myocardial infarction 8 and the low rate of myocardial infarction among patients with suggestive symptoms. 9 …”

mentioning

confidence: 99%

Acute Aortic Dissection Related to Crack Cocaine

et al. 2002

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Background-Although single case reports have described acute aortic dissection in relation to cocaine use, this condition is not widely recognized, and the features of cocaine-related aortic dissection have not been defined. Methods and Results-We reviewed all available hospital charts from 1981 to 2001 with the ICD-9 diagnosis of aortic dissection. Among the 38 cases of acute aortic dissection, 14 (37%) were related to cocaine use. Crack cocaine was smoked in 13 cases and powder cocaine was snorted in 1 case. The mean interval between cocaine use and the onset of symptoms was 12 hours (range, 0 to 24). Patients with cocaine-related dissection were much younger and more likely to undergo surgery compared with patients with aortic dissection without cocaine use. Most in the cocaine group were black, with a history of untreated hypertension. However, the two groups did not differ in other respects, including dissection type. Conclusions-In

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“…27 We were unable to document the timing, amount, route of ingestion, or incidence of chronic use of cocaine in our patients. However, all routes of ingestion result in high blood concentrations of cocaine, and the occurrence of MI is unrelated to the amount of the ingestion, the route of administration, or the frequency of use.…”

Section: Limitationsmentioning

confidence: 92%

Utility of Troponin I in Patients with Cocaine-associated Chest Pain

et al. 2002

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Baseline electrocardiogram abnormalities and marker elevations not associated with myocardial necrosis make accurate diagnosis of myocardial infarction (MI) difficult in patients with cocaine-associated chest pain. Troponin sampling may offer greater diagnostic utility in these patients. Objective: To assess outcomes based on troponin positivity in patients with cocaine chest pain admitted for exclusion of MI. Methods: Outcomes were examined in patients admitted for possible MI after cocaine use. All patients underwent a rapid rule-in protocol that included serial sampling of creatine kinase (CK), CK-MB, and cardiac troponin I (cTnI) over eight hours. Outcomes included CK-MB MI (CK-MB Ն 8 ng/mL with a relative index [(CK-MB ϫ 100)/total CK] Ն 4, cardiac death, and significant coronary disease (Ն50%). Results: Of the 246 admitted patients, 34 (14%) met CK-MB criteria for MI and 38 (16%) had cTnI elevations. Angiography was performed in 29 of 38 patients who were cTnI-positive, with significant disease present in 25 (86%). Three of the four patients without significant disease who had cTnI elevations met CK-MB criteria for MI, and the other had a peak CK-MB level of 13 ng/mL. Sensitivities, specificities, and positive and negative likelihood ratios for predicting cardiac death or significant disease were high for both CK-MB MI and cTnI and were not significantly different. Conclusions: Most patients with cTnI elevations meet CK-MB criteria for MI, as well as have a high incidence of underlying significant disease. Troponin appears to have an equivalent diagnostic accuracy compared with CK-MB for diagnosing necrosis in patients with cocaine-associated chest pain and suspected MI.

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Chest Pain Associated With Cocaine: An Assessment of Prevalence in Suburban and Urban Emergency Departments

Cited by 99 publications

References 35 publications

The effect of cardiac troponin testing on clinical care in a veterans population

The effect of cardiac troponin testing on clinical care in a veterans population

Acute Aortic Dissection Related to Crack Cocaine

Utility of Troponin I in Patients with Cocaine-associated Chest Pain

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