Acute cardiac ischemia in patients with cocaine-associated complaints: Results of a multicenter trial

Study objective: To describe the characteristics of a large group of patien ts who presented to emergency departments with cocaine-associated symptoms consistent with acute cardiac ischemia (ACI) and to determine the incidence of confirmed ACI including acute myocardial infarction (AMI) in this popul ation. Methods: We performed a substudy on all patients in a multicenter prospecti ve clinical trial (the Acute Cardiac Ischemia-Time Insensitive Predictive I nstrument [ACI-TIPI] Clinical Trial) that enrolled ED patients with chest p ain or other symptoms consistent with ACI including subjects with identifie d cocaine use. Demographic and clinical features, including initial and fol low-up clinical data, ECGs, and tests to determine serum creatine kinase is oenzyme MB subunit concentrations, were analyzed. Diagnoses of AMI followed the World Health Organization criteria for AMI and of angina pectoris, the Canadian Cardiovascular Society Classification. Results: Of the 10,689 patients enrolled in the trial, 293 (2.7%) had cocai ne-associated complaints. Among the 10 participating hospitals, the inciden ce of patients with cocaine-associated symptoms varied from 0.3% to 8.4%. O nly 6 patients (2.0%, 95% confidence interval [CI] 0.76% to 4.4%) had a dia gnosis of ACI; 4 (1.4%, 95% CI 0.37% to 3.5%) had unstable angina, and 2 (0 .7%, 95% Ci 0.08% to 2.4%) had AMI. Although patients with cocaine-induced complaints were as likely to be admitted to the coronary care unit compared with all study patients without cocaine use (14% versus 18%, P=.14, differ ence not significant), these patients were much less likely to have confirm ed unstable angina (1.4% versus 9.3%, P<.001) or AMI (0.7% versus 8.6%, P<. 001). Compared with patients younger than 45 years, patients with cocaine u sage were more likely to be admitted to the ICU (14% versus 8.0%, P=.0018) but less likely to have confirmed AMI (0.7% versus 2.8%, P=.033). Conclusion: Patients presenting to EDs with cocaine-associated chest pain o r related symptoms infrequently had ACI, and even less so, AMI. This sugges ts the need for selectivity in the hospitalization of patients with such co caine-associated symptoms.