CHEST PAIN ASSOCIATED WITH COCAINE - AN ASSESSMENT OF PREVALENCE IN SUBURBAN AND URBAN EMERGENCY DEPARTMENTS

Study objective: Chest pain and myocardial infarction following the us e of cocaine have been well documented. We assessed the prevalence of cocaine use in patients who presented to the emergency department with chest pain of possibly ischemic origin. Design: During times of resea rch assistant availability, consecutive adults with the chief complain t of chest pain unexplained by trauma or radiographic abnormality were questioned about cocaine use in the preceding week. Urine was tested for the presence of cocaine or cocaine metabolites with a highly accur ate bedside urine test kit (specificity, 100%; sensitivity 98%). Anony mous unlinked data-collection methods were used. Therefore we could no t determine whether the patients who used cocaine had sustained myocar dial infarctions. Setting: One suburban and three urban EDs. Results: We enrolled 359 patients with a mean age of 51 years, 8% of whom susta ined myocardial infarctions. Sixty patients (17%) had cocaine or cocai ne metabolites in urine. The likelihood of testing positive for cocain e varied by age group: 18 to 30 years, 29%; 31 to 40 years, 48%; 41 to 50 years, 18%; 51 to 60 years, 3%; 61 years or older, 0% (P<.0001). O f the 60 patients who tested positive for cocaine, only 43 (72%) admit ted recent use. Conclusion: Many ED patients with chest pain have rece ntly used cocaine. Because the recent use of cocaine is not uncommon i n patients with chest pain up to 60 years old, such patients should be questioned about cocaine use. When treatment or disposition may be al tered, consideration should be given to objective assessment of cocain e use because patient self-report does not appear reliable.