Cocaine users represent an emergency department (ED) population that has been shown
to be at increased risk for acute coronary syndrome (ACS); however, there is controversy
about whether this higher risk is mediated through advanced atherosclerosis. Thus,
we aimed to determine whether history of cocaine use is associated with ACS and coronary
artery disease. In this matched cohort study, we selected patients with a history
of cocaine use and age- and gender-matched controls from a large cohort of consecutive
patients who presented with acute chest pain to the ED. Coronary atherosclerotic plaque
as detected by 64-slice coronary computed tomography was compared between the groups.
Among 412 patients, 44 had a history of cocaine use (9%) and were matched to 132 controls
(mean age 46 ± 6 years, 86% men). History of cocaine use was associated with a sixfold
higher risk for ACS (odds ratio 5.79, 95% confidence interval 1.24 to 27.02, p = 0.02),
but was not associated with a higher prevalence of any plaque, calcified plaque, or
noncalcified plaque (all p>0.58) or the presence of significant stenosis (p = 0.09).
History of cocaine use was also not associated with the extent of any, calcified,
or noncalcified plaque (all p>0.12). These associations persisted after adjustment
for other cardiovascular risk factors. In conclusion, in patients presenting to the
emergency department with acute chest pain, history of cocaine use is associated with
an increase in risk for ACS; however, this was not attributable to a higher presence
or extent of coronary atherosclerotic plaque.
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Article info
Publication history
Published online: December 22, 2008
Accepted:
November 9,
2008
Received in revised form:
November 9,
2008
Received:
September 25,
2008
Footnotes
This work was supported by Grant R0-1HL0800-53 from the National Institutes of Health and in part supported by Siemens Medical Solutions, Forcheim, Germany, and General Electric, Milwaukee, Wisconsin. Drs. Rogers and Truong received support from NIH grant T32HL076136.
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© 2009 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
