Article Text

other Versions

PDF
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. 1Department of Medicine, Division of Cardiovascular Medicine, John Hopkins University School of Medicine, Baltimore, Maryland, USA
  2. 2Department of Medicine, Division of Cardiovascular Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
  3. 3Department of Medicine, Division of Cardiovascular Medicine, Ohio State University, Columbus, Ohio, USA
  4. 4Department of Medicine, Division of Cardiovascular Medicine, Baylor College of Medicine, Houston, Texas, USA
  5. 5Department 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}osumc.edu

Abstract

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

Statistics from Altmetric.com

Footnotes

  • 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.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.