Coronary computerized tomography angiography for rapid discharge of low-risk patients with cocaine-associated chest pain

Kristy M. Walsh, Anna Marie Chang, Jeanmarie Perrone, Christine M. McCusker, Frances S. Shofer, Mark J. Collin, Harold I. Litt, Judd E. Hollander

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background: Most patients presenting to emergency departments (EDs) with cocaine-associated chest pain are admitted for at least 12 hours and receive a "rule out acute coronary syndrome" protocol, often with noninvasive testing prior to discharge. In patients without cocaine use, coronary computerized tomography angiography (CTA) has been shown to be useful for identifying a group of patients at low risk for cardiac events who can be safely discharged. It is unclear whether a coronary CTA strategy would be efficacious in cocaine-associated chest pain, as coronary vasospasm may account for some of the ischemia. We studied whether a negative coronary CTA in patients with cocaine-associated chest pain could identify a subset safe for discharge. Methods: We prospectively evaluated the safety of coronary CTA for low-risk patients who presented to the ED with cocaineassociated chest pain (self-reported or positive urine test). Consecutive patients received either immediate coronary CTA in the ED (without serial markers) or underwent coronary CTA after a brief observation period with serial cardiac marker measurements. Patients with negative coronary CTA (maximal stenosis less than 50%) were discharged. The main outcome was 30-day cardiovascular death or myocardial infarction. Results: A total of 59 patients with cocaine-associated chest pain were evaluated. Patients had a mean age of 45.6 ± 6.6 yrs and were 86% black, 66% male. Seventy-nine percent had a normal or nonspecific ECG and 85% had a TIMI score

Original languageEnglish (US)
Pages (from-to)111-119
Number of pages9
JournalJournal of Medical Toxicology
Volume5
Issue number3
DOIs
StatePublished - Sep 2009
Externally publishedYes

Fingerprint

Angiography
Computerized tomography
Chest Pain
Cocaine
Tomography
Hospital Emergency Service
Coronary Vasospasm
Electrocardiography
Acute Coronary Syndrome
Pathologic Constriction
Ischemia
Myocardial Infarction
Observation
Urine
Testing
Safety

Keywords

  • Acute coronary syndrome
  • Chest pain
  • Cocaine
  • Complications
  • Computerized tomography
  • Observation units
  • Risk stratification

ASJC Scopus subject areas

  • Health, Toxicology and Mutagenesis
  • Toxicology

Cite this

Walsh, K. M., Chang, A. M., Perrone, J., McCusker, C. M., Shofer, F. S., Collin, M. J., ... Hollander, J. E. (2009). Coronary computerized tomography angiography for rapid discharge of low-risk patients with cocaine-associated chest pain. Journal of Medical Toxicology, 5(3), 111-119. https://doi.org/10.1007/BF03161220

Coronary computerized tomography angiography for rapid discharge of low-risk patients with cocaine-associated chest pain. / Walsh, Kristy M.; Chang, Anna Marie; Perrone, Jeanmarie; McCusker, Christine M.; Shofer, Frances S.; Collin, Mark J.; Litt, Harold I.; Hollander, Judd E.

In: Journal of Medical Toxicology, Vol. 5, No. 3, 09.2009, p. 111-119.

Research output: Contribution to journalArticle

Walsh, KM, Chang, AM, Perrone, J, McCusker, CM, Shofer, FS, Collin, MJ, Litt, HI & Hollander, JE 2009, 'Coronary computerized tomography angiography for rapid discharge of low-risk patients with cocaine-associated chest pain', Journal of Medical Toxicology, vol. 5, no. 3, pp. 111-119. https://doi.org/10.1007/BF03161220
Walsh, Kristy M. ; Chang, Anna Marie ; Perrone, Jeanmarie ; McCusker, Christine M. ; Shofer, Frances S. ; Collin, Mark J. ; Litt, Harold I. ; Hollander, Judd E. / Coronary computerized tomography angiography for rapid discharge of low-risk patients with cocaine-associated chest pain. In: Journal of Medical Toxicology. 2009 ; Vol. 5, No. 3. pp. 111-119.
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