![]() ![]() 13 Autopsy reports and small observational studies have suggested that chronic cocaine users may develop coronary artery disease (CAD) at younger than expected ages. 12 Acutely, cocaine causes increased myocardial oxygen demand, coronary vasoconstriction, platelet aggregation, and in situ thrombus formation, 12 which can lead to AMI even in patients with normal coronary arteries. The pathophysiology of MI in cocaine users is multifactorial. 3 Although reported rates of acute myocardial infarction (AMI) vary widely (1%–31%), 4- 10 those studies specifically designed to determine the rate of AMI in ED patients with cocaine-associated chest pain have found rates of approximately 6% 9, 10 one out of every four AMIs in people aged 18 to 45 years can be linked to cocaine use. 2 Chest pain is a common complication of cocaine use, accounting for 40% of patients who present to the ED after cocaine use. 1 In 2005, cocaine was the most common illicit drug leading to emergency department (ED) visits and accounted for over 30% of all drug related encounters. There was also no relationship between repetitive cocaine use and coronary calcifications or between recent cocaine use and CAD.Ĭonclusions: In symptomatic ED patients at low to intermediate risk of an ACS, cocaine use was not associated with an increased likelihood of coronary disease after adjustment for age, race, sex, and other risk factors for coronary disease.Īpproximately 2.4 million people habitually use cocaine in the United States, making it the second most widely used illicit drug. In multivariate modeling adjusting for age, race, sex, cardiac risk factors, and Thrombosis in Myocardial Infarction (TIMI) score, cocaine use was not associated with the presence of any coronary lesion (adjusted RR = 0.95, 95% CI = 0.69 to 1.31) or coronary lesions 50% or greater (adjusted RR = 0.78, 95% CI = 0.45 to 1.38). In univariate analysis, cocaine use was not associated with a lesion 25% or greater (12% vs. A total of 231 patients had CAD ≥ 25% 111 had CAD ≥ 50%. Results: Of 912 enrolled patients, 157 (17%) used cocaine. Prespecified multivariate modeling (generalized estimating equations) was used to assess relationship between cocaine and CAD. Patients were classified into three groups with respect to CAD: maximal stenosis <25%, 25% to 49%, and ≥50%. Methods: The authors conducted a cross-sectional study of low- to intermediate-risk patients < 60 years of age who received coronary computerized tomographic angiography (CTA) for evaluation of coronary artery disease (CAD) in the ED. The study objective was to determine whether cocaine use is associated with coronary disease in low- to intermediate-risk emergency department (ED) patients with potential acute coronary syndrome (ACS). Objectives: Observational studies of patients with cocaine-associated myocardial infarction have suggested more coronary disease than expected on the basis of patient age. ACADEMIC EMERGENCY MEDICINE 2011 18:1–9 © 2011 by the Society for Academic Emergency Medicine Abstract ![]()
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