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Outcomes of beta blocker use in cocaine-associated chest pain: a meta-analysis
  1. Don Pham1,
  2. Daniel Addison2,3,
  3. Waleed Kayani4,
  4. Arunima Misra4,
  5. Hani Jneid4,5,
  6. Jon Resar1,
  7. Nassir Lakkis4,
  8. Mahboob Alam4
  1. 1 Department of Medicine, Division of Cardiovascular Medicine, John Hopkins University School of Medicine, Baltimore, Maryland, USA
  2. 2 Department of Medicine, Division of Cardiovascular Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
  3. 3 Department of Medicine, Division of Cardiovascular Medicine, Ohio State University, Columbus, Ohio, USA
  4. 4 Department of Medicine, Division of Cardiovascular Medicine, Baylor College of Medicine, Houston, Texas, USA
  5. 5 Department of Medicine, Division of Cardiovascular Medicine, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
  1. Correspondence to Dr Daniel Addison, Ohio State University, Columbus, OH, USA ; daniel.addison{at}


Objectives Beta blockers (β-blockers) remain a standard therapy in the early treatment of acute coronary syndromes. However, β-blocker therapy in patients with cocaine-associated chest pain (CACP) continues to be an area of debate due to the potential risk of unopposed α-adrenergic stimulation and coronary vasospasm. Therefore, we performed a systematic review and meta-analysis of available studies to compare outcomes of β-blocker versus no β-blocker use among patients with CACP.

Methods We searched the MEDLINE and EMBASE databases through September 2016 using the keywords ‘beta blocker’, ‘cocaine’ and commonly used β-blockers (‘atenolol’, ‘bisoprolol’, ‘carvedilol’, ‘esmolol’, ‘metoprolol’ and ‘propranolol’) to identify studies evaluating β-blocker use among patients with CACP. We specifically focused on studies comparing outcomes between β-blocker versus no β-blocker usage in patients with CACP. Studies without a comparison between β-blocker and no β-blocker use were excluded. Outcomes of interest included non-fatal myocardial infarction (MI) and all-cause mortality. Quantitative data synthesis was performed using a random-effects model and heterogeneity was assessed using Q and I2statistics.

Results A total of five studies evaluating 1794 subjects were included. Overall, there was no significant difference on MI in patients with CACP on β-blocker versus no β-blocker (OR 1.36, 95% CI 0.68 to 2.75; p=0.39). Similarly, there was no significant difference in all-cause mortality in patients on β-blocker versus no β-blocker (OR 0.68, 95% CI 0.26 to 1.79; p=0.43).

Conclusions In patients presenting with acute chest pain and underlying cocaine, β-blocker use does not appear to be associated with an increased risk of MI or all-cause mortality.

  • acute coronary syndrome
  • cardiac care, treatment

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  • DP and DA contributed equally.

  • Contributors DP, DA and MA extracted and reviewed the data. MA performed the analysis. All authors reviewed, contributed and approved the final manuscript.

  • Funding Dr Addison is supported by a K12-CA133250 grant . The remaining authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

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

  • Presented at Interim analysis was presented at the American College of Cardiology Scientific Sessions, 2015.