Disclosures: Drs. Hollander and Litt have received research funding from Siemens. The other authors have no disclosures to report.
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Relationship Between Cocaine Use and Coronary Artery Disease in Patients With Symptoms Consistent With an Acute Coronary Syndrome
Article first published online: 23 DEC 2010
DOI: 10.1111/j.1553-2712.2010.00955.x
© 2010 by the Society for Academic Emergency Medicine
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How to Cite
Chang, A. M., Walsh, K. M., Shofer, F. S., McCusker, C. M., Litt, H. I. and Hollander, J. E. (2011), Relationship Between Cocaine Use and Coronary Artery Disease in Patients With Symptoms Consistent With an Acute Coronary Syndrome. Academic Emergency Medicine, 18: 1–9. doi: 10.1111/j.1553-2712.2010.00955.x
Supervising Editor: Stephen Smith, MD.
Publication History
- Issue published online: 10 JAN 2011
- Article first published online: 23 DEC 2010
- Received April 23, 2010; revision received May 26, 2010; accepted May 27, 2010.
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ACADEMIC EMERGENCY MEDICINE 2011; 18:1–9 © 2011 by the Society for Academic Emergency Medicine
Abstract
Objectives: Observational studies of patients with cocaine-associated myocardial infarction have suggested more coronary disease than expected on the basis of patient age. 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).
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. Patients were classified into three groups with respect to CAD: maximal stenosis <25%, 25% to 49%, and ≥50%. Prespecified multivariate modeling (generalized estimating equations) was used to assess relationship between cocaine and CAD.
Results: Of 912 enrolled patients, 157 (17%) used cocaine. A total of 231 patients had CAD ≥ 25%; 111 had CAD ≥ 50%. In univariate analysis, cocaine use was not associated with a lesion 25% or greater (12% vs. 14%; relative risk [RR] = 0.89, 95% confidence interval [CI] = 0.5 to 1.4) or 50% or greater (12% vs. 11%; RR = 1.15, 95% CI = 0.6 to 2.3). 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). There was also no relationship between repetitive cocaine use and coronary calcifications or between recent cocaine use and CAD.
Conclusions: 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.