| Kossowsky WA et al, 1989, USA | 19 patients presenting with chest pain shortly after intranasal, iv or smoking of cocaine | Prospective cohort study | Incidence of AMI | 17 (89%) that demonstrate non-Q wave infarction | Small study |
| | | | | Hospitalised patients only |
| | | | 2 with Q wave infarction | |
| | | Coronary angiogram | 5 patients: | |
| | | | 4 normal coronary arteries | |
| | | | 1 proximal stenosis of right coronary artery | |
| Amin M et al, 1990, USA | 70 patients with cocaine associated chest pain | Retrospective cohort study | Incidence of AMI | 22/70 (31%) | Small study |
| | | Sensitivity of ECG | 91% | Hospitalised patients only |
| | | Specificity of ECG | 60% | |
| Zimmerman JL et al, 1991, USA | 48 admitted patients with cocaine associated chest pain | Retrospective case note review | Incidence of AMI | 3/48 (6%) | Wide distribution of time between use and presentation |
| | | Number of patients with ECG criteria for thrombolysis | 18/48 (37%) | |
| | | | | Not ED patients |
| Gitter MJ et al, 1991, USA | 101 admitted patients with cocaine associated chest pain | Prospective cohort study | Incidence of AMI | No patients had AMI confirmed | Poor gold standard used. CK rises or CKMB fractions |
| | | Number of patients with ECG criteria for thrombolysis | 8 (8%) | |
| Hollander JE et al, 1994, USA | 246 patients presenting with cocaine associated chest pain in 6 US centres | Prospective cohort study | Incidence of AMI | 14/246 (6%) | Gold standard was a twofold rise in CKMB |
| | | Sensitivity of ECG for AMI | 36% | Not consecutive enrolment of patients |
| | | PPV of ECG for AMI | 18% | |
| | | Specificity of ECG for AMI | 90% | |
| | | PPV of ECG for AMI | 96% | |
| Mittelman MA et al, 1999, USA | Interviewed 3946 patients with AMI (an average of 4 days after infarction onset) | Case cross over study | 38 (1%) reported cocaine use in the previous year. 9 reported cocaine use within the 60 minutes preceding the onset of infarction | The users of cocaine sustained a transient 24-fold increase in risk of MI in the hour immediately after cocaine use and that the increased risk rapidly decreased thereafter | Data based on patient self report |
| | | | | Small number of exposed cases |
| | | | | The absolute risk of MI onset cannot be directly estimated from the data |
| Weber JE et al, 2000, USA | 250 patients presenting with cocaine associated chest pain in 29 US centres AMI diagnosed on WHO criteria | Prospective cohort study | Incidence of AMI | 15/250 (6%) | Wide distribution of time between use and presentation (up to 7 days) |
| | | Number with ECG changes compatible with ischaemia | 39/250 of which 4 had confirmed AMI | |
| | | | | 6% had no urinary metabolites |
| | | Number with ECG changes compatible with infarction | 9/250 of which all had confirmed AMI | Gold standard was a twofold rise in CKMB |
| | | Number without ECG changes who had confirmed infarction | 2/67 had confirmed AMI | Most (91%) patients used crack cocaine |
| Feldman JA et al, 2000, USA | 293 patients with cocaine associated chest pain. Sub-study of the Aci-TIPI trial | Prospective cohort study | Incidence of AMI | (0.7%) CI 0.08% to 2.4% with cocaine | Sub study of another trial. |
| | | Incidence of ACS | 1.4% CI 0.37% to 3.5% | WHO criteria for AMI |
| | | | | Wide variation of AMI incidence between hospitals |