Management of Cocaine-Associated Chest Pain and Myocardial Infarction

McCord, James; Jneid, Hani; Hollander, Judd E.; Lemos, James A. de; Cercek, Bojan; Hsue, Priscilla Y.; Gibler, W. Brian; Ohman, E. Magnus; Drew, Barbara J.; Philippides, George J.; Newby, L. Kristin

doi:10.1161/circulationaha.107.188950

Cited by 369 publications

(154 citation statements)

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“…However, most patients in this study and prior studies of patients with cocaine-associated chest pain are not tachycardic [7,8,10,59]. There are some patients with tachycardia after cocaine use who may not be candidates for coronary CTA because most protocols for noncocaine-using patients require administration of betaadrenergic blockers for heart rate control, and these agents should be avoided in the setting of cocaine [41,50]. Use of CT scanners with higher temporal resolution, such as the dual source machine used later in our study, may relax the requirement for strict heart rate control; however, our sample was too small to evaluate any effects of this technology.…”

Section: Limitationsmentioning

confidence: 85%

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Coronary computerized tomography angiography for rapid discharge of low-risk patients with cocaine-associated chest pain

et al. 2009

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Background: Most patients presenting to emergency departments (EDs) with cocaine-associated chest pain are admitted for at least 12 hours and receive a "rule out acute coronary syndrome" protocol, often with noninvasive testing prior to discharge. In patients without cocaine use, coronary computerized tomography angiography (CTA) has been shown to be useful for identifying a group of patients at low risk for cardiac events who can be safely discharged. It is unclear whether a coronary CTA strategy would be efficacious in cocaine-associated chest pain, as coronary vasospasm may account for some of the ischemia. We studied whether a negative coronary CTA in patients with cocaine-associated chest pain could identify a subset safe for discharge.Methods: We prospectively evaluated the safety of coronary CTA for low-risk patients who presented to the ED with cocaineassociated chest pain (self-reported or positive urine test). Consecutive patients received either immediate coronary CTA in the ED (without serial markers) or underwent coronary CTA after a brief observation period with serial cardiac marker measurements. Patients with negative coronary CTA (maximal stenosis less than 50%) were discharged. The main outcome was 30-day cardiovascular death or myocardial infarction.Results: A total of 59 patients with cocaine-associated chest pain were evaluated. Patients had a mean age of 45.6 Ϯ 6.6 yrs and were 86% black, 66% male. Seventy-nine percent had a normal or nonspecific ECG and 85% had a TIMI score <2. Twenty patients received coronary CTA immediately in the ED, 18 of whom were discharged following CTA (90%). Thirty-nine received coronary CTA after a brief observation period, with 37 discharged home following CTA (95%). Six patients had coronary stenosis Ն50%. During the 30-day follow-up period, no patients died of a cardiovascular event (0%; 95% CI, 0-6.1%) and no patient sustained a nonfatal myocardial infarction (0%; 95% CI, 0-6.1%).Conclusions: Although cocaine-associated myocardial ischemia can result from coronary vasoconstriction, patients with cocaineassociated chest pain, a non-ischemic ECG, and a TIMI risk score <2 may be safely discharged from the ED after a negative coronary CTA with a low risk of 30-day adverse events.

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Section: Limitationsmentioning

confidence: 85%

“…The current American College of Cardiology/American Heart Association (ACC/AHA) recommendations include a 9-to 12-hour observation period followed by stress testing for cocaine-induced chest pain [50]. Stress tests can be used to assess low-and moderate-risk patients with cocaine-associated chest pain.…”

Section: Discussionmentioning

confidence: 99%

Coronary computerized tomography angiography for rapid discharge of low-risk patients with cocaine-associated chest pain

et al. 2009

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“…In our patients, we preferred not to prescribe beta blockers as it is contraindicated in case of cocaine intoxication because of the risk of coronary vasospasm and myocardial infarction 11. For ventricular tachycardia, implantable cardioverter defibrillator implantation should be deferred until resolution of the acute episode.…”

Section: Discussionmentioning

confidence: 99%

Ventricular tachycardia revealing drug abuse induced myocarditis: two case reports

Ouali

Guermazi

Halima

et al. 2018

Clinical Case Reports

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“…Only recently, a BVS stent was implanted in a coronary dissection [20]. When coronary angioplasty is the choice, the American Heart Association guideline recommend [21] very careful consideration of the probability of long-term compliance before a drug-eluting stent is used in a patient with cocaine-associated myocardial infarction. To the best of our knowledge, no data are available regarding the use of BVS system in patients with cocaine-induced SCAD during ACS, but they would be expected to have the same advantages [22] as in patients who do not …”

Section: Case Historymentioning

confidence: 99%

Spontaneous Coronary Artery Dissection and Implantation of Absorb Bioresorbable Drug-Eluting Stent in Cocaine-Related Acute Coronary Syndrome

Ceravolo¹,

Vatrano²,

Dattilo³

et al. 2014

J Cardiovasc Med Cardiol

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Management of Cocaine-Associated Chest Pain and Myocardial Infarction

Cited by 369 publications

References 116 publications

Coronary computerized tomography angiography for rapid discharge of low-risk patients with cocaine-associated chest pain

Coronary computerized tomography angiography for rapid discharge of low-risk patients with cocaine-associated chest pain

Ventricular tachycardia revealing drug abuse induced myocarditis: two case reports

Spontaneous Coronary Artery Dissection and Implantation of Absorb Bioresorbable Drug-Eluting Stent in Cocaine-Related Acute Coronary Syndrome

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