• Temple EM

Beta-Blockers for Chest Pain Associated with Recent Cocaine Use

The Article: Beta-blockers for Chest Pain Associated with Recent Cocaine Use

Arch Intern Med. 2010 May 24.

The Idea: To determine whether beta blockers are detrimental to patients who have recently used cocaine

The Study:

-Single centered retrospective cohort study of 331 consecutive patients admitted to the hospital

-Inclusion criteria: chief complaint of chest pain, positive urine drug screen for cocaine, admitted

-Exclusion criteria: chest pain secondary to a pulmonary etiology (ex: PE) diagnosed in the emergency department

-Primary outcome = death

-Secondary outcome = peak troponin level at 24 hours, Vfib/Vtach requiring defibrillation, need for intubation, need for vasopressors, cardiovascular death determined by death certificates from National Death Index

The Findings:

No significant difference in end points between patients who received a beta-blocker while in the ED or while admitted compared to those who did not

Trend toward improved survival when discharged home with a beta blocker

Limitations:

Retrospective review

No standardized approach to who received beta blockers and who did not

Urine drug screen only looked for cocaine metabolites so data as to when the drug was ingested or how much cannot be garnered

Significant baseline differences between the two study groups

The Takeaway:

Beta blockers have been shown to improve mortality during ACS but the fear of unopposed alpha stimulation has prevented practitioners from using beta-blockers when the patient is concomitantly using cocaine. This study gives some evidence that this effect may not be real and beta blockers may have mortality benefit in the outpatient setting.

#Cardiovascular #Toxicology

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