Address for correspondence:
Robert C. Hendel, MD
Division of Cardiovascular Medicine
Department of Medicine University of
Miami Miller School of Medicine
1120 14th Street, CRB #1123
Miami, FL 33136
Cocaine-Using Patients With a Normal
or Nondiagnostic Electrocardiogram:
Single-Photon Emission Computed
Tomography Myocardial Perfusion Imaging
Robert C. Hendel, MD; Robin Ruthazer, MPH; Sandra Chaparro, MD; Claudia
Martinez, MD; Harry P. Selker, MD; Joni R. Beshansky, RN, MPH; James E. Udelson, MD
Division of Cardiovascular Medicine, Department of Medicine (Hendel, Chaparro, Martinez),
University of Miami Miller School of Medicine, Miami, Florida; Department of Medicine Tufts
Medical Center (Ruthazer, Selker, Beshansky, Udelson), Boston, Massachusetts
Background: Few trials have examined the outcomes of patients who use cocaine with chest pain and who
have a normal or nondiagnostic electrocardiogram (ECG) and the use of single-photon emission computed
tomography (SPECT) myocardial perfusion imaging (MPI).
Hypothesis: We sought to compare the characteristics and overall outcomes in cocaine users vs non-cocaine
users presenting to the emergency department with a normal/nondiagnostic ECG and to assess the value of
rest MPI in both of these populations.
Methods: Patients with symptoms compatible with myocardial ischemia, suspected acute coronary syndrome
(ACS), and a normal/nondiagnostic ECG were enrolled in the Emergency Room Assessment of Sestamibi for
of rest MPI on triage decisions. Cocaine users (n = 294) were compared to non-cocaine users (n = 2180).
Cocaine users were younger than non-cocaine users, and 72% were male.
Results: Among the cocaine users, 2.4% had a myocardial infarction, 1.4% required percutaneous coronary
intervention, and none of the patients underwent coronary artery bypass graft surgery. Among cocaine users
with a final diagnosis of not ACS, randomization of patients to rest SPECT MPI resulted in an appropriate
reduction in hospital admissions in both the cocaine users (P = 0.011) and the non-cocaine users (P < 0.001),
suggesting improved triage when MPI was used.
Conclusions: Cocaine users with a normal/nondiagnostic ECG are at low risk of cardiac events. Even though
cocaine users are at low risk of cardiac events, SPECT MPI remains effective in the risk stratification and
improves triage management decisions resulting in lower admission rates and more discharges to home.
Over 440000 patients have had cocaine-related visits to the
and this number is expected to continue increasing.1,2The
This work was supported by grant number RO1-HS09110 from
the Agency for Healthcare Research and Quality, and in part
by the General Clinical Research Centers at Tufts Medical
Center (MO1-RR00054), Northwestern Memorial Hospital
(MO1-RR00048), and Boston Medical Center (MO1-RR00533),
funded by the NIH National Center for Research Resources.
The authors have no other funding, financial relationships, or
conflicts of interest to disclose.
major concerns of this presentation are the cardiovascular
complications of cocaine-associated chest pain, including
myocardial ischemia, myocardial infarction (MI), acceler-
ated atherosclerosis, coronary vasoconstriction, arrhyth-
mias, sudden death, and myocarditis.1The pathogenesis
of cocaine-related myocardial ischemia and infarction is
multifactorial: an increased myocardial oxygen demand in
a limited or fixed supply, marked vasoconstriction of the
coronary arteries, and enhanced platelet aggregation and
The majority of studies related to cocaine-associated
complications have focused on patients presenting with
an abnormal electrocardiogram (ECG) and chest pain. Of
these, 0.7% to 6% were found to have an acute MI.5Few
354Clin. Cardiol. 35, 6, 354–358 (2012)
Published online in Wiley Online Library (wileyonlinelibrary.com)
DOI:10.1002/clc.21977 © 2012 Wiley Periodicals, Inc.
Received: October 12, 2011
Accepted with revision: January 26, 2012