Sehatbakhsh Samineh, Kushnir Alexander, Furlan Stefanie, Donath Elie, Ghumman Waqas, Chait Robert
From the University of Miami Miller School of Medicine, Graduate Medical Education, Department of Medicine, Devision of Cardiology at JFK Medical Center, Atlantis, FL.
Crit Pathw Cardiol. 2018 Sep;17(3):147-150. doi: 10.1097/HPC.0000000000000147.
Current guidelines recommend treating patients with cocaine-associated chest pain, unstable angina, or myocardial infarction similarly to patients with traditional acute coronary syndrome (ACS). Risk stratifying these patients could potentially reduce unnecessary procedures and improve resource utilization.
This is a retrospective cross-sectional analysis of 258 patients presenting with cocaine-associated ACS who underwent cardiac catheterization in a community teaching hospital between 2006 and 2015. The primary outcome was the prevalence of acute obstructive coronary artery disease (CAD) requiring percutaneous coronary intervention and coronary artery bypass grafting compared with that of patients with normal coronary or nonobstructive disease.
Of the studied population, 36% had obstructive CAD requiring intervention and 64% were found to have normal coronaries or nonobstructive disease. Significant risk factors for obstructive CAD were older age, history of CAD, diabetes mellitus, dyslipidemia, ST-segment-elevation myocardial infarction, and troponin elevation. A logistic model was developed based on these variables, applied to the studied population, and was found to have 93% sensitivity in predicting the likelihood of obstructive CAD.
Cardiac catheterization in patients presenting with cocaine-associated ACS may be overutilized. A predictive model based on clinical risk factors may help individualize patient care and reduce unnecessary invasive diagnostic interventions.
当前指南建议，对于患有可卡因相关性胸痛、不稳定型心绞痛或心肌梗死的患者，应与传统急性冠状动脉综合征（ACS）患者进行类似的治疗。对这些患者进行风险分层可能会减少不必要的检查，并提高资源利用效率。
这是一项对258例患有可卡因相关性ACS且于2006年至2015年期间在一家社区教学医院接受心脏导管插入术的患者进行的回顾性横断面分析。主要结局是与冠状动脉正常或无阻塞性疾病的患者相比，需要进行经皮冠状动脉介入治疗和冠状动脉搭桥术的急性阻塞性冠状动脉疾病（CAD）的患病率。
在研究人群中，36%患有需要干预的阻塞性CAD，64%被发现冠状动脉正常或患有非阻塞性疾病。阻塞性CAD的显著危险因素包括年龄较大、CAD病史、糖尿病、血脂异常、ST段抬高型心肌梗死和肌钙蛋白升高。基于这些变量建立了一个逻辑模型，并应用于研究人群，结果发现该模型在预测阻塞性CAD可能性方面具有93%的敏感性。
对于患有可卡因相关性ACS的患者，心脏导管插入术可能存在过度使用的情况。基于临床危险因素的预测模型可能有助于实现个体化患者护理，并减少不必要的侵入性诊断干预措施。
