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Prevalence of cocaine use among patients attending the emergency department with chest pain
  1. Tanya Maric1,
  2. Sally O'Connor1,
  3. Noel Pollock2,
  4. Zul Mirza1,
  5. John Henry3
  1. 1West Middlesex University Hospital, London, Middlesex, UK
  2. 2UKA, London, UK
  3. 3St Mary's Hospital, London, UK
  1. Correspondence to Dr Tanya Maric, West Middlesex University Hospital, Twickenham Road, Isleworth, London, TW7 6AF, UK; tanyamaric{at}hotmail.com

Abstract

Introduction Cocaine is the only drug to show a rise in misuse between 1996 and 2007 in England and Wales. It can cause chest pain and myocardial infarction. This study assessed the prevalence of cocaine use in patients presenting with chest pain, and determined the association between cocaine use and chest pain.

Methods Patients presenting with chest pain had a urine sample collected at presentation. Each patient with chest pain was matched with a non-chest pain control. Demographic detail, drug history and clinical outcome was recorded, samples anonymised and subsequently tested for cocaine and metabolites.

Results Of the 1469 patients, 101 (6.9%) tested positive for cocaine compared with 3.8% of controls (p<0.001). Men (8%) were more likely than women (5.1%) to test positive for cocaine. Two patients developed a myocardial infarction. Cocaine use was highest in those aged 18–30 years for both sexes and decreased with age. Cocaine-positive patients with chest pain were more likely to present in the evening, after midnight or at the weekend. Only 18% of all patients presenting with chest pain had a specific drug history recorded in their notes.

Conclusions As many patients do not admit to use of an illegal drug, routine testing would enable cocaine-related ischaemic events to be identified more easily but this remains controversial. As management of cocaine-induced chest pain is different from other causes of chest pain, doctors should routinely question patients with chest pain about cocaine use in addition to well recognised risk factors.

  • Cocaine
  • chest pain
  • myocardial infarction
  • drug misuse
  • education
  • cardiac care, acute myocardial infarct
  • cardiac care, acute coronary syndrome
  • clinical assessment, education
  • emergency care systems, emergency departments
  • mental health, drug abuse

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Footnotes

  • JH is deceased.

  • Funding Euromed provided the Sure-Step urine cocaine tests.

  • Competing interests None.

  • Ethical approval St Mary's Hospital Ethics Committee and Charing Cross Hospital Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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