NITROGLYCERIN IN THE TREATMENT OF COCAINE-ASSOCIATED CHEST PAIN - CLINICAL SAFETY AND EFFICACY

The optimal medical regimen for the treatment of cocaine associated my ocardial ischemia has not been defined. While animal and human data de monstrate the risks of beta-adrenergic blockade, studies in the cardia c catheterization laboratory suggest a beneficial role of nitroglyceri n. We performed a prospective multicenter observational study to evalu ate the clinical safety and efficacy of nitroglycerin in the treatment of cocaine associated chest pain at six municipal hospital centers. O f 246 patients presenting with cocaine associated chest pain, 83 patie nts were treated with nitroglycerin at the discretion of the treating physician. Relief of chest pain and/or adverse hemodynamic outcome wer e the primary endpoints. Baseline comparisons of patients treated with nitroglycerin to those not treated with nitroglycerin found that the treated patients were at higher risk of ischemic heart disease. They w ere older (36 years vs 32 years, p = 0.0008), more likely to have an i schemic electrocardiogram (27% vs 4%, p < 0.0001), to be admitted (94% vs 40%, p < 0.0001), and to have a discharge diagnosis of ischemic he art disease (41% vs 9%, p < 0.0001). Nitroglycerin was beneficial in 4 1 patients (49%; 95% CI, 38-60%): 37 patients (45%) had relief or redu ction in the severity of chest pain and 4 patients (5%) had other bene ficial effects. Only one patient had an adverse outcome (transient hyp otension in the setting of a right ventricular infarct). Nitroglycerin is safe and possibly effective in the treatment of cocaine associated chest pain.