Cocaine‐associated Chest Pain How Common Is Myocardial Infarction?

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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 cocaine‐associated 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 ± 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.