Espana Schmidt Christian, Pastori Luciano, Pekler Gerald, Visco Ferdinand, Mushiyev Savi
Department of Medicine, Metropolitan Hospital Center/New York Medical College, New York, NY, United States.
Unit of Cardiology, Department of Medicine, Metropolitan Hospital Center/New York Medical College, New York, NY, United States.
Int J Cardiol Heart Vasc. 2015 Jun 14;8:167-169. doi: 10.1016/j.ijcha.2015.06.001. eCollection 2015 Sep 1.
The most common symptom of cocaine abuse is chest pain. Cocaine induced chest pain (CICP) shares patho-physiological pathways with the acute coronary syndromes (ACS). A key event is the increase of activity of the adrenergic system. Beta blockers (BBs), a cornerstone in the treatment of ACS, are felt to be contraindicated in the patient with CICP due to a potential of an "unopposed alpha adrenergic effect (UAE)".
Identify signs of UAE and in-hospital complications in patients who received BB while having cocaine induced chest pain.
We performed a retrospective review of 378 patients admitted to a medical unit because of CICP. Twenty six of these were given a BB at the time of admission while having CICP. We compared these patients to a control group paired by age, sex, race and history of hypertension who did not received a BB while having CICP. Blood pressure, heart rate, length of stay and in-hospital cardiovascular complications were compared.
No statistically significant differences were found between the two groups except for a longer length of stay in the case group. This was felt to be due to unrelated causes.
This study does not support the presence of an UAE in patients with continuing CICP and treated early with BB. There were no in-hospital cardiovascular complications in the group of patients who had an early dose of BB while having CICP.
BB appeared safe when given early on admission to patients with CICP.
可卡因滥用最常见的症状是胸痛。可卡因诱发的胸痛（CICP）与急性冠脉综合征（ACS）具有共同的病理生理途径。一个关键事件是肾上腺素能系统活性增加。β受体阻滞剂（BBs）是ACS治疗的基石，但由于存在“未对抗的α肾上腺素能效应（UAE）”的可能性，在CICP患者中被认为是禁忌的。
识别在因可卡因诱发胸痛而接受BB治疗的患者中UAE的体征和院内并发症。
我们对378例因CICP入住内科病房的患者进行了回顾性研究。其中26例在因CICP入院时接受了BB治疗。我们将这些患者与一组在因CICP入院时未接受BB治疗、按年龄、性别、种族和高血压病史配对的对照组进行比较。比较了两组的血压、心率、住院时间和院内心血管并发症。
除病例组住院时间较长外，两组之间未发现统计学上的显著差异。这被认为是由无关原因导致的。
本研究不支持在持续CICP且早期接受BB治疗的患者中存在UAE。在因CICP入院时早期接受BB治疗的患者组中未出现院内心血管并发症。
在CICP患者入院早期给予BB似乎是安全的。
