Cocaine-Associated Myocardial Infarction

Hollander, Judd E.; Hoffman, Robert S.; Shih, Richard D.; Thode, Henry C.; Bartfield, Joel M.; Raccio‐Robak, Nancy; Harchelroad, Fred; Nelson, Lewis S.; Sandoval, Marcelo; Feldman, James A.; Fish, Susan S.; Wallace, C. J.; Paynter, Ronald; Whelan, Chris; Silverman, Robert A.; Scheppke, Kenneth; Thomaser, Hilary; Doyon, Suzanne; Wax, Paul M.; Lopez, Bernard L.; Imbesi, Joseph; Giroski, Laura; Burstein, Jonathan L.; Shepherd, Suzanne M.; Sparkes, Mary L.; Seger, Donna; Goetz, Robert J.; Morgan, David L.; Wilhelm, Ginger W.; Schumb, David A.; Sporer, Karl A.; Sutton, Brian J.; Ling, Louis J.; Wilson, Lance D.; Hoekstra, James W.; Kulig, Ken; Phillips, Scott; Brent, Jeffrey; Watson, William A.; Quick, Annette; Thodejr, Henry C.

doi:10.1001/archinte.1995.00430100117013

Cited by 133 publications

(16 citation statements)

References 25 publications

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“…All aspects of the medical record were reviewed to obtain information for documentation using a previously described closed-question data collection instrument with excellent interrater reliability for all predictor and outcome variables. 12 Emergency physicians maintained the option of using a template for ''chest pain'' complete with risk factors and chest pain characteristics that otherwise may have been difficult to retrieve in a retrospective manner. In cases where reports were dictated and information was missing, documentation from the cardiologist's consultation and houseofficer history and physical examinations were utilized.…”

Section: Methodsmentioning

confidence: 99%

“…They were young, predominantly male (76%), cigarette smokers (77%), with chronic cocaine abuse. [5][6][7][8][9][10][11][12] Other than tobacco use, traditional risk factors for coronary artery disease were present less frequently than among patients with chest pain presumed to be of ischemic origin. 4,7,9,16 Although low-risk groups of traditional patients who may be safely admitted to intermediate care units have been identified, 17 a group of cocaine-associated chest pain patients who can be safely released from the ED based on explicit criteria has not been validated.…”

Section: Limitations and Future Questionsmentioning

confidence: 98%

“…Although retrospective chart review is inherently subject to some limitations, we used a data collection instrument that has been shown to have excellent interrater reliability for both predictor and outcome variables. 12 Our criteria specifically required chest pain as a chief complaint, in addition to recent cocaine use. Therefore, it is possible that patients presenting without chest pain, yet having symptoms consistent with ischemia (e.g., dyspnea, palpitations, shortness of breath), were missed.…”

Section: Limitations and Future Questionsmentioning

confidence: 99%

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Cocaine‐associated Chest Pain How Common Is Myocardial Infarction?

Weber

Chudnofsky

Boczar

et al. 2000

Academic Emergency Medicine

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Abstract.Objective: Prior studies addressing the incidence of acute myocardial infarction (AMI) in patients with cocaine-associated chest pain have found divergent results. Previous prospective studies, which found approximately a 6% incidence of AMI, have been criticized for selection bias. This study sought to determine the rate of AMI in patients with cocaineassociated chest pain. Methods: All patients seen in an urban university-affiliated hospital between July 1996 and February 1998 were identified by ICD-9 medical records search for cocaine use and chest pain/ acute coronary syndromes. In this system, all faculty admit all patients with cocaine-associated chest pain for at least 23-hour observation periods. Data collected included demographics, medical and cocaine use history, presenting characteristics, hospital course, cardiovascular complications, and diagnostic tests using a 119-item closed-question data instrument with high interrater reliability. The main outcome measure was AMI according to World Health Organization (WHO) criteria. Results: There were 250 patients identified with a mean age of 33.5 Ϯ 8.5 years; 77% were male; 84% were African American. Of 196 patients tested, 185 had cocaine or cocaine metabolites in the urine (94%). The incidence of cardiac risk factors were: hypercholesterolemia, 8%; diabetes, 6%; family history, 34%; hypertension, 26%; tobacco use, 77%; prior MI, 6%; and prior chest pain, 40%. Seventy-seven percent admitted to cocaine use in the preceding 24 hours: crack, 85%; IV, 2%; nasal, 6%. Twenty-five patients (10%) had electrocardiographic evidence of ischemia. A total of 15 patients experienced an AMI (6%; 95% CI = 4.1% to 8.9%) using WHO criteria. Complications were infrequent: bradydysrrhythmias, 0.4%; congestive heart failure, 0.4%; supraventricular tachycardia, 1.2%; sustained ventricular tachycardia, 0.8%. Conclusion: The incidence of AMI was 6% in patients with cocaine-associated chest pain. This result is identical to that found in prior prospective studies. Key words: cocaine; acute coronary syndrome; acute myocardial infarction; emergency department; electrocardiogram. ACADEMIC EMERGENCY MEDICINE 2000; 7: 873-877 C OCAINE use is associated with a 24-fold increased risk of myocardial infarction during the hour immediately after use.1 Acute myocardial infarction (AMI) due to cocaine occurs in patients with and without diseased coronary arteries.2-4 Although recent data suggest that cocaine-associated chest pain is infrequently ischemic in nature, 5 chest pain remains the most frequent cocaine-associated emergency department (ED) complaint. 6 Previous studies have found a widely divergent incidence of AMI in patients with cocaine-associated chest pain, largely due to selection bias. COCHPA (Cocaine Associated Chest Pain) trial was the largest multicenter study to prospectively evaluate the incidence of cocaine-associated myocardial infarction. 11 That study determined the prevalence to be 6%. 11The purpose of this study was to determine the frequency of AMI in patie...

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Section: Methodsmentioning

confidence: 99%

Section: Limitations and Future Questionsmentioning

confidence: 98%

Section: Limitations and Future Questionsmentioning

confidence: 99%

See 1 more Smart Citation

Cocaine‐associated Chest Pain How Common Is Myocardial Infarction?

Weber

Chudnofsky

Boczar

et al. 2000

Academic Emergency Medicine

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125

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“…In Maryland state prisons, for the period of 1979-1987, circulatory system diseases were the most frequent cause of death. Some researchers argue that one of the reasons for high mortality rate for heart disease is that a disproportionately high number of inmates abuse substances such as alcohol, tobacco and predominantly cocaine [25]. Forensic mental health treatment centres operate with a variety of professional staff (Psychiatrists, psychologists, nurses, social workers and security staff, etc.)…”

Section: Introductionmentioning

confidence: 99%

Trends and causes of psychiatric inpatient deaths: A ten-year retrospective study at a secure forensic psychiatric centre in Canada

Adelugba¹,

Mela²,

Haq³

2018

Forensic Sci Criminol

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Psychiatric inpatient population within the correctional system is different from psychiatric inpatient facilities in the community. This study aimed to better understand the trends and causes of deaths among inpatients in a secure forensic psychiatric centre. Data collected on all deaths during a ten-year period revealed that there were 18 natural deaths (Crude Mortality Rate (CMR) of 9.6 per 1000 per year) and one death due to suicide (CMR = 0.6 per 1000 per year) constituting an overall CMR of 10.2 per 1000 per year. Among the 19 deaths during the study period, 18 (94.7%) were pre-mature (< 75 years of age). The average potential years of life lost was 22.3 years (SD = 10.8, n = 18, 95% CI = 16.9 -27.6). Respiratory diseases (44.4%, n = 8) were a leading cause of natural deaths followed by gastrointestinal diseases (38.9%, n = 7), cardiovascular diseases (11.1%, n = 2), and renal diseases (5.6%, n = 1). Nurses attended to the deceased patients on the day of their deaths in all cases and the interval in terms of the number of days a patient was seen by clinical staff prior to death was least for the nursing staff compared to other staff categories (Mean = 1.1, SD = 1.4, n = 19). In conclusion, most of the deaths were pre-mature, due to natural causes and death by suicide was extremely uncommon at the study site. Similar studies need to be conducted in other centres.

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“…The differential diagnosis of cocaine-related chest pain is broad and includes acute coronary syndrome (ACS), aortic dissection, pneumothorax, pneumomediastinum, pneumopericardium, and pulmonary infarction [3][4][5][6][7][8]. Diagnostic and treatment strategies are similar to that of other ED patients with chest pain.…”

Section: Introductionmentioning

confidence: 99%

Phentolamine therapy for cocaine-associated acute coronary syndrome (CAACS)

et al. 2006

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INTRODUCTIONCocaine abuse accounts for over 64,000 ED visits annually, of which more than 50% are chest pain related [1,2]. The differential diagnosis of cocaine-related chest pain is broad and includes acute coronary syndrome (ACS), aortic dissection, pneumothorax, pneumomediastinum, pneumopericardium, and pulmonary infarction [3][4][5][6][7][8]. Diagnostic and treatment strategies are similar to that of other ED patients with chest pain. However, when considering the therapy of CAACS, strategies differ. For cocaine exposure, coronary artery vasoconstriction is mediated by alphaadrenergic stimulation [5]. We are presenting the second published case of CAACS with electrocardiogram (ECG) abnormalities that resolved when the use of an alpha-adrenergic receptor antagonist, phentolamine, was implemented. CASE REPORTA 43-year-old man with a history of depression presented to the emergency department (ED) with a chief complaint of left sided chest pain that began 1 hour after insufflating cocaine. The pain was described as an intense ache that was a "10 out of 10" in terms of its intensity, and it radiated to his left shoulder. He attempted to alleviate his symptoms by drinking ethanol to "bring him down" but this was unsuccessful at relieving the pain. A similar event happened two weeks prior, also during cocaine use, and the patient was admitted to a hospital and diagnosed with CAACS. His evaluation (including serum troponin levels over a 24-hour period, echocardiogram, and exercise stress test) was normal. He was discharged on aspirin, diltiazem, nitroglycerin, and referred to a Case report: We are reporting on the treatment of a patient with cocaine-associated acute coronary syndrome (CAACS) who did not benefit from standard therapy, but who eventually responded positively to phentolamine, an alpha-adrenergic receptor antagonist.Discussion: This report should encourage physicians to add phentolamine to their pharmacotherapeutic armamentarium in the treatment of CAACS.

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Cocaine-Associated Myocardial Infarction

Abstract: The mortality of patients hospitalized with cocaine-associated myocardial infarction was low. The majority of complications occurred within 12 hours of presentation.

Cited by 133 publications

References 25 publications

Cocaine‐associated Chest Pain How Common Is Myocardial Infarction?

Cocaine‐associated Chest Pain How Common Is Myocardial Infarction?

Trends and causes of psychiatric inpatient deaths: A ten-year retrospective study at a secure forensic psychiatric centre in Canada

Phentolamine therapy for cocaine-associated acute coronary syndrome (CAACS)

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