Circulation. 2000;101:e227
(Circulation. 2000;101:e227.)
© 2000 American Heart Association, Inc.
Circulation Electronic Pages |
Risk of Acute Myocardial Infarction in Cocaine Abusers
Tsung O. Cheng, MD
Professor of Medicine George Washington University,
Washington, DC 20037
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Introduction
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To the Editor:
I read with interest but some skepticism the article on the triggering
of myocardial infarction by cocaine by Mittleman et al.1
They reported that in the first hour after cocaine use, the risk of
acute myocardial infarction was 23.7 times greater than the baseline
risk (95% confidence interval, 8.5 to 66.3) during periods of
nonexposure to cocaine.
Unfortunately, this study was retrospective and included only admitted
patients, as was a similar study reported by Amin et al,2
which had an incidence of cocaine-associated myocardial infarction as
high as 31%. Three recent prospective studies that included patients
who were discharged from the emergency departments of the hospitals
found a much lower incidence, ranging from 2.5% to
8.7%,3 with an approximate average of
6%.4 5
The low frequency of myocardial infarction reported by such prospective
studies is in contrast to the high frequency reported by retrospective
studies and has obvious clinical implications. Observation units in the
emergency departments may offer an alternative to routine hospital
admissions to coronary care units for evaluating patients with
cocaine-associated chest pains, with or without abnormal
electrocardiograms. Such a cost-saving approach will
have a significant financial impact in the current environment of
managed care, because chest pain is the most common cocaine-related
symptom among patients presenting to the emergency department.
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References
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Mittleman MA, Mintzer D, Maclure M, et
al. Triggering of myocardial infarction by cocaine.
Circulation. 1999;99:2737–2741.[Abstract/Free Full Text]
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Amin M, Gabelman G, Karpel J, et al. Acute myocardial
infarction and chest pain syndrome after cocaine use. Am J
Cardiol. 1990;66:1434–1437.[Medline]
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Kontos MC, Schmidt KL, Nicholson CS, et al. Myocardial
perfusion imaging with technetium-99m sestamibi in patients
with cocaine-associated chest pain. Ann Emerg Med. 1999;33:639–645.[Medline]
[Order article via Infotrieve]
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Tokarski GF, Pagenussi P, Urbanski R, et al. An
evaluation of cocaine-induced chest pain. Ann Emerg Med. 1990;19:1088–1092.[Medline]
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Hollander JE, Hoffman RS, Gennis P, et al. Prospective
multicenter evaluation of cocaine-associated chest pain: Cocaine
Associated Chest Pain (COCHPA) Study Group. Acad Emerg Med. 1994;1:330–339.[Medline]
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Introduction
References