Hospital Admissions for Chest Pain Associated with Cocaine Use in the United States

Am J Med. 2017 Jun;130(6):688-698. doi: 10.1016/j.amjmed.2016.12.003. Epub 2017 Jan 4.

Abstract

Background: The outcomes related to chest pain associated with cocaine use and its burden on the healthcare system are not well studied.

Methods: Data were collected from the Nationwide Inpatient Sample (2001-2012). Subjects were identified by using the International Classification of Diseases, Ninth Revision, Clinical Modification codes. Primary outcome was a composite of mortality, myocardial infarction, stroke, and cardiac arrest.

Results: We identified 363,143 admissions for cocaine-induced chest pain. Mean age was 44.9 (±21.1) years with male predominance. Left heart catheterizations were performed in 6.7%, whereas the frequency of acute myocardial infarction and percutaneous coronary interventions were 0.69% and 0.22%, respectively. The in-hospital mortality was 0.09%, and the primary outcome occurred in 1.19% of patients. Statistically significant predictors of primary outcome included female sex (odds ratio [OR], 1.16; confidence interval [CI], 1.00-1.35; P = .046), age >50 years (OR, 1.24, CI, 1.07-1.43; P = .004), history of heart failure (OR, 1.63, CI, 1.37-1.93; P <.001), supraventricular tachycardia (OR, 2.94, CI, 1.34-6.42; P = .007), endocarditis (OR, 3.5, CI, 1.50-8.18, P = .004), tobacco use (OR, 1.3, CI, 1.13-1.49; P <.001), dyslipidemia (OR, 1.5, CI, 1.29-1.77; P <.001), coronary artery disease (OR, 2.37, CI, 2.03-2.76; P <.001), and renal failure (OR, 1.27, CI, 1.08-1.50; P = .005). The total annual projected economic burden ranged from $155 to $226 million with a cumulative accruement of more than $2 billion over a decade.

Conclusion: Hospital admissions due to chest pain and concomitant cocaine use are associated with low rates of adverse outcomes. For the low-risk cohort in whom acute coronary syndrome has been ruled out, hospitalization may not be beneficial and may result in unnecessary cardiac procedures.

Keywords: Chest pain; Cocaine use; Mortality; Myocardial infarction; Percutaneous coronary intervention.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Cardiovascular Diseases / diagnosis
  • Cardiovascular Diseases / therapy
  • Chest Pain / etiology*
  • Chest Pain / therapy
  • Cocaine-Related Disorders / complications*
  • Cost of Illness
  • Female
  • Hospital Mortality
  • Hospitalization / statistics & numerical data*
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction / diagnosis
  • Myocardial Infarction / therapy
  • Percutaneous Coronary Intervention
  • Risk Factors
  • Tobacco Use Disorder / complications
  • Young Adult