COCAINE-ASSOCIATED CHEST PAIN - ONE-YEAR FOLLOW-UP

Objective: To determine the one-year mortality and incidence of myocar dial infarction (MI) post-hospital discharge or ED release for patient s with cocaine-associated chest pain. Methods: A prospective. observat ional study of an inception cohort of consecutive patients who present ed to one of four municipal hospital EDs with cocaine-associated chest pain. Patients were followed for one year from the end of the enrollm ent period. Main outcome parameters were the one-year actuarial surviv al and the frequency of nonfatal MI. Results: Mortality data were avai lable for all 203 patients at a mean of 408 days. Additional clinical information was available for 185 patients (91%). There were six death s (one-year actuarial survival 98%; 95% CI, 95-100%); none from MI. No nfatal MI occurred in two patients (1%; 95% CI, 0-2%). Continued cocai ne use was common (60%; 95% CI, 52-68%) and was associated with recurr ent chest pain (75% vs 31%, p < 0.0001). No MI or death was reported f or patients who claimed to have ceased cocaine use. Conclusions: Patie nts who presented with cocaine-associated chest pain commonly continue d to use cocaine after discharge. Urgent evaluation of coronary anatom y or cardiac stress tests may not be necessary for patients for whom M I is ruled out and who do not have recurrent potentially ischemic pain . The subsequent risk for MI and death in this group appears to be low . Intervention strategies should emphasize cessation of cocaine use.