Prevalence, Clinical Characteristics and Risk of Myocardial Infarction in Patients With Cocaine-Related Chest Pain

Introduction and objectives. To investigate the frequency of recent cocaine use in patients attending an emergency department for acute chest pain, to describe the clinical characteristics of these patients, and to estimate the incidence of acute coronary syndrome in this population. Methods. Observational cohort study using a standard questionnaire that includes items on recent cocaine consumption. Results. During a 1-year period, 1240 patients aged under 55 years presented with chest pain. Of these, 63 (5%) had cocaine-related chest pain (7% of men and 1.8% of women). These patients were younger (35 +/- 10 years vs. 39 +/- 10 years; P=.002), were more frequently male (87% vs. 62%; P<.001), and were more frequently smokers (59% vs. 35%; P<.001). Patients who had used cocaine recently had a higher incidence of acute myocardial infarction (16 vs. 4%; P<.001), especially ST-segment-elevation myocardial infarction (11.1% vs. 1.6%; P<.01). After adjusting for coronary risk factors, history of cardiovascular disease and previous treatment, the odds ratio for myocardial infarction with recent cocaine consumption was 4.3 (95% confidence interval, 2-9.4). Conclusions. Cocaine-related chest pain is often encountered in emergency departments, especially in men aged under 55 years. It is associated with a four-fold increase in the risk of acute myocardial infarction. All male patients aged under 55 years with acute chest pain should be asked about cocaine use.