Shin Doosup, Lee Eun Sun, Bohra Chandrashekar, Kongpakpaisarn Kullatham
Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, FL 33606, USA.
Department of Internal Medicine, Weiss Memorial Hospital, Chicago, IL 60640, USA.
Cardiol Res. 2019 Feb;10(1):40-47. doi: 10.14740/cr831. Epub 2019 Feb 24.
Although β-blocker treatment is generally contraindicated in patients presenting with acute cocaine intoxication due to concern for unopposed α-receptor stimulation, some studies have reported that β-blocker treatment did not increase adverse events in these patients. As this treatment is still controversial, we performed a meta-analysis of observational studies on this topic.
By searching three electronic databases (MEDLINE, EMBASE, and the Cochrane Library) from their inception to June 11, 2018, we identified eight observational studies with 2,048 patients who presented to hospital with cocaine-associated chest pain or after recent cocaine use. Outcomes of interest were myocardial necrosis or infarction (MI) and death during hospital stay or follow-up. Pooled relative risks (RRs) with 95% confidence intervals (CIs) were calculated by using a random-effects meta-analysis based on the DerSimonian-Laird method.
Among patients presenting with cocaine-associated chest pain or recent cocaine use, there was no significant difference in in-hospital all-cause mortality (RR, 0.59; 95% CI, 0.24 - 1.47) and MI (RR, 1.24; 95% CI, 0.74 - 2.06) between patients who did and did not receive β-blocker treatment during their hospital stay. During long-term follow-up (mean 2.6 years), there was no significant difference in all-cause mortality (RR, 0.79; 95% CI, 0.44 - 1.41) and MI (RR, 0.96; 95% CI, 0.40 - 2.33) between the two groups.
These results suggest that β-blocker treatment in patients presenting with cocaine intoxication may not be as harmful as originally believed. Further clinical studies are needed to investigate this topic.
尽管由于担心α受体无对抗性刺激，β受体阻滞剂治疗在急性可卡因中毒患者中通常是禁忌的，但一些研究报告称，β受体阻滞剂治疗并未增加这些患者的不良事件。由于这种治疗仍存在争议，我们对关于该主题的观察性研究进行了荟萃分析。
通过检索三个电子数据库（MEDLINE、EMBASE和Cochrane图书馆），从其创建到2018年6月11日，我们确定了八项观察性研究，涉及2048例因可卡因相关性胸痛或近期使用可卡因后入院的患者。感兴趣的结局是住院期间或随访期间的心肌坏死或梗死（MI）以及死亡。使用基于DerSimonian-Laird方法的随机效应荟萃分析计算合并相对风险（RRs）及其95%置信区间（CIs）。
在因可卡因相关性胸痛或近期使用可卡因就诊的患者中，住院期间接受和未接受β受体阻滞剂治疗的患者之间，全因死亡率（RR，0.59；95%CI，0.24 - 1.47）和MI（RR，1.24；95%CI，0.74 - 2.06）没有显著差异。在长期随访（平均2.6年）期间，两组之间的全因死亡率（RR，0.79；95%CI，0.44 - 1.41）和MI（RR，0.96；95%CI，0.40 - 2.33）没有显著差异。
这些结果表明，可卡因中毒患者使用β受体阻滞剂治疗可能不像最初认为的那样有害。需要进一步的临床研究来调查这个主题。
