Young patients with acute coronary syndrome (ACS) who admit to using cocaine are no more likely to have coronary artery disease (CAD) than young symptomatic patients who haven't used the drug, new research shows.
Based on the findings, "one needs to be less concerned about the chronic effects and more concerned about the acute effects when you see a patient with cocaine-associated chest pain," Dr Judd E. Hollander of the University of Pennsylvania in Philadelphia, the study's lead author, told.
"We had a worry that a cocaine-using 25- or 30-year-old might have more coronary artery disease than would be otherwise predicted," the researcher explained.
These concerns were based on small case studies that suggested accelerated development of CAD in cocaine users, Dr Hollander said. However, he and his colleagues add in the Annals of Emergency Medicine, "No large studies have directly compared the prevalence of clinically relevant coronary artery disease in cocaine users and nonusers."
To investigate, Dr Hollander and his team performed a cross-sectional study of 912 patients under 60 years old who underwent coronary computerised tomographic angiography (CTA) in the emergency department. 17% admitted to cocaine use.
A total of 231 patients (25%) had maximal stenosis of 25% or greater in at least one vessel on CTA, while 111 (12%) had maximal stenosis above 50%.
Univariate analysis found no relationship between cocaine use and an increased risk of a 25% or greater or 50% or greater lesion, the researchers found. Upon adjustment for age, race, sex, cardiac risk factors, and Thrombosis in Myocardial Infarction score, there remained no relationship between cocaine use and any atherosclerotic lesion or lesions greater than 50%.
Repetitive cocaine use also wasn't linked to coronary calcifications, while recent cocaine use wasn't related to CAD.
While young patients who present to the emergency department with ACS symptoms and admit to cocaine use should be evaluated for the acute effects of the drug, Dr Hollander said, the new findings suggest that any evaluation for CAD can be done on an elective, outpatient basis rather than at the hospital. (Reuters Health/ January 2011)
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