Cocaine-Induced Chest Pain and β-Blockade: An Inner City Experience

Mohamad, Tamam; Kondur, Ashok; Vaitkevicius, Peter V.; Bachour, K.; Thatai, Deepak; Afonso, Luís

doi:10.1097/mjt.0b013e3181758cfc

Cited by 14 publications

(6 citation statements)

References 21 publications

(16 reference statements)

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“…Datillo et al evaluated 310 patients with available troponin measurements and was one of the earliest studies to assess for in-hospital mortality 15. In the Mohamad et al trial, 364 patients who presented to a Detroit emergency department with chest pain and positive urine drug screen for cocaine were included 16. Rangel et al was the first trial to incorporate both short-term and long-term mortality and included 328 patients 17.…”

Section: Resultsmentioning

confidence: 99%

Outcomes of beta blocker use in cocaine-associated chest pain: a meta-analysis

et al. 2018

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Section: Resultsmentioning

confidence: 99%

Outcomes of beta blocker use in cocaine-associated chest pain: a meta-analysis

et al. 2018

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“…14 The beta selectivity of the beta-blocker was not stated in this study. 14 By contrast, many other retrospective studies have found benefit of beta-blocker use in the setting of cocaineassociated chest pain syndrome or acute coronary syndrome. In a propensity score-matched retrospective analysis, Dattilo et al 10 showed that, among cocaine-positive patients, the incidence of myocardial infarction was lower in those who received beta-blockers (OR 0.08; 95% CI, 0.01-0.65).…”

Section: Clinical Significancementioning

confidence: 96%

Clinical Outcomes After Treatment of Cocaine-Induced Chest Pain with Beta-Blockers: A Systematic Review and Meta-Analysis

Lo¹,

Virk

Lakhter

et al. 2019

The American Journal of Medicine

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BACKGROUND: Recent guidelines have suggested avoiding beta-blockers in the setting of cocaine-associated acute coronary syndrome. However, the available evidence is both scarce and conflicted. The purpose of this systematic review and meta-analysis is to investigate the evidence pertaining to the use of betablockers in the setting of acute cocaine-related chest pain and its implication on clinical outcomes. METHODS: Electronic databases were systematically searched to identify literature relevant to patients with cocaine-associated chest pain who were treated with or without beta-blockers. We examined the endpoints of in-hospital all-cause mortality and myocardial infarction. Pooled risk ratios (RR) and their 95% confidence intervals (CI) were calculated for all outcomes using a random-effects model. RESULTS: Five studies with a total of 1447 patients were included. Our analyses found no differences between patients treated with or without beta-blockers for either myocardial infarction (RR 1.08; 95% CI, 0.61-1.91) or all-cause mortality (RR 0.75; 95% CI, 0.46-1.24). Heterogeneity among included studies was low to moderate. CONCLUSION: This systematic review and meta-analysis suggests that beta-blocker use is not associated with adverse clinical outcomes in patients presenting with acute chest pain related to cocaine use.

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“…After excluding 168 studies based on titles and abstracts, the full texts of 50 studies were reviewed. Eight cohort studies (seven retrospective [14-17, 23-25] and one prospective [18]) with 2,048 patients met the predetermined selection criteria and were included in the final study. Seven studies were published in journals [14-18, 23, 24] and one was a conference abstract [25].…”

Section: Resultsmentioning

confidence: 99%

“…Table 1 [14-18, 23-25] displays the general characteristics of the included studies. Five studies [14, 16, 17, 23, 24] reported in-hospital outcomes and three studies [15, 18, 25] reported in-hospital and/or long-term outcomes. Median or mean ages of individuals in the study population ranged from 42 to 57 years.…”

Section: Resultsmentioning

confidence: 99%

In-Hospital and Long-Term Outcomes of Beta-Blocker Treatment in Cocaine Users: A Systematic Review and Meta-analysis

et al. 2019

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Background Although β-blocker treatment is generally contraindicated in patients presenting with acute cocaine intoxication due to concern for unopposed α-receptor stimulation, some studies have reported that β-blocker treatment did not increase adverse events in these patients. As this treatment is still controversial, we performed a meta-analysis of observational studies on this topic. Methods By searching three electronic databases (MEDLINE, EMBASE, and the Cochrane Library) from their inception to June 11, 2018, we identified eight observational studies with 2,048 patients who presented to hospital with cocaine-associated chest pain or after recent cocaine use. Outcomes of interest were myocardial necrosis or infarction (MI) and death during hospital stay or follow-up. Pooled relative risks (RRs) with 95% confidence intervals (CIs) were calculated by using a random-effects meta-analysis based on the DerSimonian-Laird method. Results Among patients presenting with cocaine-associated chest pain or recent cocaine use, there was no significant difference in in-hospital all-cause mortality (RR, 0.59; 95% CI, 0.24 - 1.47) and MI (RR, 1.24; 95% CI, 0.74 - 2.06) between patients who did and did not receive β-blocker treatment during their hospital stay. During long-term follow-up (mean 2.6 years), there was no significant difference in all-cause mortality (RR, 0.79; 95% CI, 0.44 - 1.41) and MI (RR, 0.96; 95% CI, 0.40 - 2.33) between the two groups. Conclusions These results suggest that β-blocker treatment in patients presenting with cocaine intoxication may not be as harmful as originally believed. Further clinical studies are needed to investigate this topic.

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Cocaine-Induced Chest Pain and β-Blockade: An Inner City Experience

Cited by 14 publications

References 21 publications

Outcomes of beta blocker use in cocaine-associated chest pain: a meta-analysis

Outcomes of beta blocker use in cocaine-associated chest pain: a meta-analysis

Clinical Outcomes After Treatment of Cocaine-Induced Chest Pain with Beta-Blockers: A Systematic Review and Meta-Analysis

In-Hospital and Long-Term Outcomes of Beta-Blocker Treatment in Cocaine Users: A Systematic Review and Meta-analysis

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