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.
[1]
G. Burillo-Putze,et al.
Incidence and impact of undisclosed cocaine use in emergency department chest pain and trauma patients
,
2008,
International journal of emergency medicine.
[2]
J. Hoyle,et al.
Cocaine and accelerated atherosclerosis: insights from intravascular ultrasound.
,
2004,
International journal of cardiology.
[3]
L. Lemberg,et al.
The cocaine-abused heart.
,
2003,
American journal of critical care : an official publication, American Association of Critical-Care Nurses.
[4]
M. Wilkerson,et al.
Cocaine-associated chest pain: how common is myocardial infarction?
,
2000,
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.
[5]
A. Singer,et al.
Chest pain associated with cocaine: an assessment of prevalence in suburban and urban emergency departments.
,
1995,
Annals of emergency medicine.
[6]
J. Hollander.
The management of cocaine-associated myocardial ischemia.
,
1995,
The New England journal of medicine.
[7]
L. Hillis,et al.
Potentiation of cocaine-induced coronary vasoconstriction by beta-adrenergic blockade.
,
1990,
Annals of internal medicine.