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Cocaine-Related Chest Pain: The Year After

During 1 year after an ED visit for low-risk cocaine-related chest pain, patients had a very low rate of MI but a high rate of repeat ED visits, often for cocaine-related chest pain.

Most patients who present to the emergency department with chest pain in the context of recent cocaine use do not have acute coronary syndromes (ACS). These patients commonly are admitted to observation or chest pain units, where they undergo serial cardiac biomarker measurements and electrocardiography to rule out ACS and then are discharged. Rates of death and recurrent myocardial infarction within 30 days after the ED visit are very low in this population, but we don’t know much about their longer-term outcomes.

Researchers prospectively evaluated outcomes during 1 year in 219 adult patients who presented to an urban ED with chest pain related to cocaine use (positive urine toxicology) and in whom ACS was ruled out by serial cardiac biomarker measurement and 12-lead electrocardiography. All patients returned to some area of the medical center (e.g., ED, outpatient clinic, direct admission to inpatient floor) within 1 year after their index ED visits. Overall, 65% of patients returned to the ED for any reason, and 23% returned to the ED with chest pain. No patient suffered MI or cardiac death during the year after their index ED visits.

Comment: Although many patients with cocaine-related chest pain present again with chest pain, the small number of patients who actually have ACS (none in this study) argues strongly for managing these patients entirely within the ED or an ED observation unit. This practice would save precious hospital inpatient beds for higher-risk patients.

— Richard D. Zane, MD, FAAEM

Published in Journal Watch Emergency Medicine April 24, 2009

Citation(s):

Cunningham R et al. One-year medical outcomes and emergency department recidivism after emergency department observation for cocaine-associated chest pain. Ann Emerg Med 2009 Mar; 53:310.

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Reader Remarks:

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• Cocaine related chest pain in ED
  Ian Cormack, 1 May 2009 3:11 PM EST
  The report doesn't state the % of those (23%)returning with chest pain who again tested positive for cocaine. Recreational drug... [more]
• Cocaine related chest pain
  Alan A. Wartenberg, DVA Medical Center Providence, 1 May 2009 3:11 PM EST
  I wonder how many patients had effective referral to chemical dependency treatment programs.
• Cocaine-related chest pain
  James M. Madsen, Drexel University College of Medicine, Philadelphia, PA, 26 May 2009 8:28 AM EST
  I agree that the rate of ACS in patients with cocaine-associated chest pain is low. I'd also like to point... [more]