Comparison of In-Hospital Outcomes for Beta-Blocker Use Versus Non–Beta Blocker Use in Patients Presenting With Cocaine-Associated Chest Pain

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

“…In a different propensity score-matched cohort of 376 patients with cocaine-related chest pain, 44% of patients were on baseline beta-blocker therapy at the time of presentation. 15 This investigation found that, although patients using beta-blockers had higher baseline Thrombolysis in Myocardial Infarction scores, more severe coronary artery disease, and more overall traditional cardiac risk factors, their outcomes (death, stroke, myocardial infarction, arrhythmia, and a composite outcome) were similar to those patients not receiving beta-blocker therapy. Interestingly, in the case of the last 2 cohort studies discussed, 11,15 beta-blocker use may have offered a protective effect, as patients receiving this treatment had higher baseline cardiovascular risk.…”

Cardiovascular consequences of cocaine use

“…However, National Cardiovascular Data Registry data suggest that betablocker use within 24 hours of presentation is relatively high in cocaine users (85.8%) [99], and recent observational studies suggest no difference in in-hospital outcomes observed in cocaine-using patients regardless of whether they were treated with a beta-blocker [92,93]. This conflicting evidence warrants further research to clarify the role of beta-blockers in the context of acute cocaine-related cardiotoxicity.…”

“…Study authors speculated that this may be the result of predominant beta-adrenergic blocking activity when labetalol is given at standard doses [91]. More recent studies show mixed results and, at present, the role of beta-blockers in cocaine-induced cardiac dysfunction remains controversial [10,92,93]. Until more definitive data are available, considering the pharmacologic properties of individual beta-blockers in the context of cocaine use, we suggest avoiding the use of beta-blockers during acute cocaine intake presenting with acute coronary syndrome but acknowledge that use of beta-blockers after discharge may provide some benefit.…”

Características, manejo y evolución intrahospitalaria de usuarios de drogas ilícitas con infarto agudo del miocardio

“…Las guías actuales de la American Heart Association no aconsejan el uso de estos fármacos durante el período agudo de un IAM asociado a cocaína; sugiriéndose su empleo al alta sólo en pacientes con indicaciones previamente establecidas para su uso 5 . Estudios posteriores a la aparición de estas guías, sugieren que el uso de beta-bloqueadores intrahospitalario no conlleva una mayor incidencia de complicaciones del IAM asociado a cocaína [14][15][16] . Nuestros datos insinúan que en la mayoría de los casos se sigue la recomendación de las guías de la AHA, sin embargo, llama la atención que el uso de beta-bloqueadores sea particularmente reducido al egreso para ambos grupos en comparación con otros estudios poblacionales 4 .…”