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Cocaine‐associated Chest Pain: One‐year Follow‐up
Author(s) -
Hollander Judd E.,
Hoffman Robert S.,
Gennis Paul,
Fairweather Phillip,
Feldman James A.,
Fish Susan S.,
DiSano Michael J.,
Schumb David A.,
Dyer Sophia
Publication year - 1995
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/j.1553-2712.1995.tb03191.x
Subject(s) - medicine , chest pain , myocardial infarction , observational study , incidence (geometry) , prospective cohort study , cohort study , optics , physics
Objective: To determine the one‐year mortality and incidence of myocardial infarction (MI) post‐hospital discharge or ED release for patients with cocaine‐associated chest pain. Methods: A prospective, observational study of an inception cohort of consecutive patients who presented to one of four municipal hospital EDs with cocaine‐associated chest pain. Patients were followed for one year from the end of the enrollment period. Main outcome parameters were the one‐year actuarial survival and the frequency of nonfatal MI. Results: Mortality data were available for all 203 patients at a mean of 408 days. Additional clinical information was available for 185 patients (91%). There were six deaths (one‐year actuarial survival 98%; 95% CI, 95–100%); none from MI. Nonfatal MI occurred in two patients (1%; 95% CI, 0–2%). Continued cocaine use was common (60%; 95% CI, 52–68%) and was associated with recurrent chest pain (75% vs 31%, p < 0.0001). No MI or death was reported for patients who claimed to have ceased cocaine use. Conclusions: Patients who presented with cocaine‐associated chest pain commonly continued to use cocaine after discharge. Urgent evaluation of coronary anatomy or cardiac stress tests may not be necessary for patients for whom MI is ruled out and who do not have recurrent potentially ischemic pain. The subsequent risk for MI and death in this group appears to be low. Intervention strategies should emphasize cessation of cocaine use.