Feldman J A, Fish S S, Beshansky J R, Griffith J L, Woolard R H, Selker H P
Department of Emergency Medicine, Boston Medical Center, Boston University School of Medicine, MA, USA.
Ann Emerg Med. 2000 Nov;36(5):469-76. doi: 10.1067/mem.2000.110994.
To describe the characteristics of a large group of patients who presented to emergency departments with cocaine-associated symptoms consistent with acute cardiac ischemia (ACI) and to determine the incidence of confirmed ACI including acute myocardial infarction (AMI) in this population.
We performed a substudy on all patients in a multicenter prospective clinical trial (the Acute Cardiac Ischemia-Time Insensitive Predictive Instrument [ACI-TIPI] Clinical Trial) that enrolled ED patients with chest pain or other symptoms consistent with ACI including subjects with identified cocaine use. Demographic and clinical features, including initial and follow-up clinical data, ECGs, and tests to determine serum creatine kinase isoenzyme MB subunit concentrations, were analyzed. Diagnoses of AMI followed the World Health Organization criteria for AMI and of angina pectoris, the Canadian Cardiovascular Society Classification.
Of the 10,689 patients enrolled in the trial, 293 (2.7%) had cocaine-associated complaints. Among the 10 participating hospitals, the incidence of patients with cocaine-associated symptoms varied from 0.3% to 8.4%. Only 6 patients (2.0%, 95% confidence interval [CI] 0.76% to 4.4%) had a diagnosis of ACI; 4 (1.4%, 95% CI 0.37% to 3.5%) had unstable angina, and 2 (0.7%, 95% CI 0.08% to 2.4%) had AMI. Although patients with cocaine-induced complaints were as likely to be admitted to the coronary care unit compared with all study patients without cocaine use (14% versus 18%, P =.14, difference not significant), these patients were much less likely to have confirmed unstable angina (1.4% versus 9.3%, P <.001) or AMI (0. 7% versus 8.6%, P <.001). Compared with patients younger than 45 years, patients with cocaine usage were more likely to be admitted to the ICU (14% versus 8.0%, P =.0018) but less likely to have confirmed AMI (0.7% versus 2.8%, P =.033).
Patients presenting to EDs with cocaine-associated chest pain or related symptoms infrequently had ACI, and even less so, AMI. This suggests the need for selectivity in the hospitalization of patients with such cocaine-associated symptoms.
描述一大群因可卡因相关症状就诊于急诊科且符合急性心肌缺血（ACI）表现的患者特征，并确定该人群中确诊的 ACI（包括急性心肌梗死[AMI]）的发生率。
我们对一项多中心前瞻性临床试验（急性心肌缺血 - 时间不敏感预测工具[ACI - TIPI]临床试验）中的所有患者进行了一项子研究，该试验纳入了有胸痛或其他符合 ACI 表现的症状的急诊科患者，包括已确定使用可卡因的受试者。分析了人口统计学和临床特征，包括初始和随访临床数据、心电图以及用于测定血清肌酸激酶同工酶 MB 亚基浓度的检查。AMI 的诊断遵循世界卫生组织的 AMI 标准，心绞痛的诊断遵循加拿大心血管学会分类标准。
在该试验纳入的 10689 名患者中，293 名（2.7%）有可卡因相关主诉。在 10 家参与医院中，有可卡因相关症状的患者发生率从 0.3%到 8.4%不等。仅有 6 名患者（2.0%，95%置信区间[CI]为 0.76%至 4.4%）被诊断为 ACI；4 名（1.4%，95%CI 为 0.37%至 3.5%）患有不稳定型心绞痛，2 名（0.7%，95%CI 为 0.08%至 2.4%）患有 AMI。尽管与所有未使用可卡因的研究患者相比，有可卡因所致主诉的患者被收入冠心病监护病房的可能性相同（14%对 18%，P = 0.14，差异无统计学意义），但这些患者确诊不稳定型心绞痛（1.4%对 9.3%，P < 0.001）或 AMI（0.7%对 8.6%，P < 0.001）的可能性要小得多。与年龄小于 45 岁的患者相比，使用可卡因的患者更有可能被收入重症监护病房（14%对 8.0%，P = 0.0018），但确诊 AMI 的可能性较小（0.7%对 2.8%，P = 0.033）。
因可卡因相关胸痛或相关症状就诊于急诊科的患者很少发生 ACI，发生 AMI 的情况更少。这表明对于有此类可卡因相关症状的患者，住院治疗需要有选择性。
