Hollander J E, Hoffman R S, Gennis P, Fairweather P, DiSano M J, Schumb D A, Feldman J A, Fish S S, Dyer S, Wax P
Department of Emergency Medicine University Hospital, State University of New York Stony Brook 11794-7400, USA.
Acad Emerg Med. 1994 Jul-Aug;1(4):330-9. doi: 10.1111/j.1553-2712.1994.tb02639.x.
To describe a large cohort of patients who had chest pain following cocaine use, and to determine the incidence of and clinical characteristics predictive for myocardial infarction in this group of patients.
A prospective observational cohort study of consecutive patients with cocaine-associated chest pain was conducted in six municipal hospital emergency departments (EDs). Demographic variables, drug abuse patterns, medical histories, chest pain characteristics, ECG results, and laboratory data were recorded. Myocardial infarction was the primary endpoint.
Fourteen of 246 patients (5.7%; 95% confidence interval [CI], 2.7-8.7%) had myocardial infarction, as diagnosed by elevated CK-MB isoenzyme levels. There were two deaths (0.8%). The patients had a median age of 33 years. The majority were male (71.5%), non-white (83.3%), cigarette smokers (83.3%) who used cocaine regularly. Chest pain began a median of 60 minutes after cocaine use and persisted for a median of 120 minutes. Chest pain was most frequently described as substernal (71.3%) and pressure-like (46.7%). Shortness of breath (59.3%) and diaphoresis (38.6%) were common. There was no clinical difference between patients who had myocardial infarctions and those who did not. Twelve patients had arrhythmias and four had congestive heart failure. All cases requiring intervention were evident upon presentation. An ECG revealing ischemia or infarction had a sensitivity of 35.7% for predicting a myocardial infarction. The specificity, positive predictive value, and negative predictive value of the ECGs were 89.9%, 17.9%, and 95.8%, respectively.
Myocardial infarction in patients who have cocaine-associated chest pain is not uncommon. No clinical parameter available to the physician can adequately identify patients at very low risk for myocardial infarction. Therefore, all patients with cocaine-associated chest pain should be evaluated for myocardial infarction.
描述一大群使用可卡因后出现胸痛的患者，并确定该组患者中心肌梗死的发生率及预测心肌梗死的临床特征。
在六家市级医院急诊科对连续的可卡因相关性胸痛患者进行前瞻性观察队列研究。记录人口统计学变量、药物滥用模式、病史、胸痛特征、心电图结果及实验室数据。心肌梗死为主要终点。
246例患者中有14例（5.7%；95%置信区间[CI]，2.7 - 8.7%）发生心肌梗死，通过肌酸激酶同工酶（CK - MB）水平升高确诊。有2例死亡（0.8%）。患者的中位年龄为33岁。大多数为男性（71.5%）、非白人（83.3%）、经常使用可卡因的吸烟者（83.3%）。胸痛在使用可卡因后中位60分钟开始，持续中位120分钟。胸痛最常描述为胸骨后疼痛（71.3%）和压榨样疼痛（46.7%）。呼吸急促（59.3%）和出汗（38.6%）很常见。发生心肌梗死的患者与未发生心肌梗死的患者之间无临床差异。12例患者出现心律失常，4例出现充血性心力衰竭。所有需要干预的病例在就诊时均很明显。心电图显示缺血或梗死对预测心肌梗死的敏感性为35.7%。心电图的特异性、阳性预测值和阴性预测值分别为89.9%、17.9%和95.8%。
可卡因相关性胸痛患者发生心肌梗死并不罕见。医生可用的任何临床参数都无法充分识别心肌梗死极低风险的患者。因此，所有可卡因相关性胸痛患者均应评估是否发生心肌梗死。
