Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA.
Acad Emerg Med. 2011 Jan;18(1):1-9. doi: 10.1111/j.1553-2712.2010.00955.x. Epub 2010 Dec 23.
Observational studies of patients with cocaine-associated myocardial infarction have suggested more coronary disease than expected on the basis of patient age. The study objective was to determine whether cocaine use is associated with coronary disease in low- to intermediate-risk emergency department (ED) patients with potential acute coronary syndrome (ACS).
The authors conducted a cross-sectional study of low- to intermediate-risk patients<60 years of age who received coronary computerized tomographic angiography (CTA) for evaluation of coronary artery disease (CAD) in the ED. Patients were classified into three groups with respect to CAD: maximal stenosis <25%, 25% to 49%, and ≥50%. Prespecified multivariate modeling (generalized estimating equations) was used to assess relationship between cocaine and CAD.
Of 912 enrolled patients, 157 (17%) used cocaine. A total of 231 patients had CAD ≥25%; 111 had CAD ≥50%. In univariate analysis, cocaine use was not associated with a lesion 25% or greater (12% vs. 14%; relative risk [RR]=0.89, 95% confidence interval [CI]=0.5 to 1.4) or 50% or greater (12% vs. 11%; RR=1.15, 95% CI=0.6 to 2.3). In multivariate modeling adjusting for age, race, sex, cardiac risk factors, and Thrombosis in Myocardial Infarction (TIMI) score, cocaine use was not associated with the presence of any coronary lesion (adjusted RR=0.95, 95% CI=0.69 to 1.31) or coronary lesions 50% or greater (adjusted RR=0.78, 95% CI=0.45 to 1.38). There was also no relationship between repetitive cocaine use and coronary calcifications or between recent cocaine use and CAD.
In symptomatic ED patients at low to intermediate risk of an ACS, cocaine use was not associated with an increased likelihood of coronary disease after adjustment for age, race, sex, and other risk factors for coronary disease.
对可卡因相关性心肌梗死患者的观察性研究表明，可卡因的使用与基于患者年龄的预期相比，与更多的冠状动脉疾病相关。本研究的目的是确定可卡因的使用是否与低至中度风险急诊科（ED）中具有潜在急性冠状动脉综合征（ACS）的患者的冠状动脉疾病（CAD）相关。
作者对低至中度风险、年龄<60 岁的 ED 患者进行了一项横断面研究，这些患者因 CAD 接受了冠状动脉计算机断层扫描血管造影（CTA）评估。根据 CAD 情况，将患者分为三组：最大狭窄<25%、25%-49%和≥50%。使用预设的多变量模型（广义估计方程）来评估可卡因与 CAD 之间的关系。
在纳入的 912 名患者中，有 157 名（17%）使用了可卡因。共有 231 名患者的 CAD≥25%，111 名患者的 CAD≥50%。在单变量分析中，可卡因的使用与狭窄程度为 25%或以上（12%比 14%；相对风险[RR]=0.89，95%置信区间[CI]为 0.5 至 1.4）或 50%或以上（12%比 11%；RR=1.15，95% CI 为 0.6 至 2.3）的病变无相关性。在多变量模型中，通过调整年龄、种族、性别、心脏危险因素和血栓形成的心肌梗死（TIMI）评分，可卡因的使用与任何冠状动脉病变（校正 RR=0.95，95% CI 为 0.69 至 1.31）或冠状动脉病变 50%或以上（校正 RR=0.78，95% CI 为 0.45 至 1.38）无相关性。反复使用可卡因与冠状动脉钙化之间也没有关系，最近使用可卡因与 CAD 之间也没有关系。
在 ACS 低至中度风险的症状性 ED 患者中，调整年龄、种族、性别和其他 CAD 危险因素后，可卡因的使用与冠状动脉疾病的发生几率增加无关。
