Cocaine-associated chest pain: how common is myocardial infarction?

Acad Emerg Med. 2000 Aug;7(8):873-7. doi: 10.1111/j.1553-2712.2000.tb02064.x.


Objective: Prior studies addressing the incidence of acute myocardial infarction (AMI) in patients with cocaine-associated chest pain have found divergent results. Previous prospective studies, which found approximately a 6% incidence of AMI, have been criticized for selection bias. This study sought to determine the rate of AMI in patients with cocaine-associated chest pain.

Methods: All patients seen in an urban university-affiliated hospital between July 1996 and February 1998 were identified by ICD-9 medical records search for cocaine use and chest pain/ acute coronary syndromes. In this system, all faculty admit all patients with cocaine-associated chest pain for at least 23-hour observation periods. Data collected included demographics, medical and cocaine use history, presenting characteristics, hospital course, cardiovascular complications, and diagnostic tests using a 119-item closed-question data instrument with high interrater reliability. The main outcome measure was AMI according to World Health Organization (WHO) criteria.

Results: There were 250 patients identified with a mean age of 33.5 +/- 8.5 years; 77% were male; 84% were African American. Of 196 patients tested, 185 had cocaine or cocaine metabolites in the urine (94%). The incidence of cardiac risk factors were: hypercholesterolemia, 8%; diabetes, 6%; family history, 34%; hypertension, 26%; tobacco use, 77%; prior MI, 6%; and prior chest pain, 40%. Seventy-seven percent admitted to cocaine use in the preceding 24 hours: crack, 85%; IV, 2%; nasal, 6%. Twenty-five patients (10%) had electrocardiographic evidence of ischemia. A total of 15 patients experienced an AMI (6%; 95% CI = 4.1% to 8.9%) using WHO criteria. Complications were infrequent: bradydysrrhythmias, 0.4%; congestive heart failure, 0.4%; supraventricular tachycardia, 1.2%; sustained ventricular tachycardia, 0.8%.

Conclusion: The incidence of AMI was 6% in patients with cocaine-associated chest pain. This result is identical to that found in prior prospective studies.

MeSH terms

  • Adult
  • Blood Pressure
  • Cocaine / adverse effects*
  • Cocaine / blood
  • Cocaine / urine
  • Cocaine-Related Disorders / epidemiology*
  • Electrocardiography
  • Emergency Service, Hospital
  • Female
  • Humans
  • Incidence
  • Male
  • Medical Records Systems, Computerized
  • Myocardial Infarction / chemically induced*
  • Myocardial Infarction / diagnosis
  • Myocardial Infarction / epidemiology
  • Retrospective Studies
  • Risk Factors
  • Trauma Centers


  • Cocaine