β-Blockers Are Associated With Reduced Risk of Myocardial Infarction After Cocaine Use

Philip B. Dattilo, Susan M. Hailpern, Kerrie Fearon, Davendra Sohal, Charles W. Nordin

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Abstract

Study objective: β-Blocker use is associated with coronary artery spasm after cocaine administration but also decreases mortality in patients with myocardial infarction or systolic dysfunction. We conduct a retrospective cohort study to analyze the safety of β-blockers in patients with positive urine toxicology results for cocaine. Methods: The cohort consisted of 363 consecutive telemetry and ICU patients who were admitted to a municipal hospital and had positive urine toxicology results for cocaine during a 5-year period (307 patients). Fifteen patients with uncertain history of β-blocker use before admission were excluded. The primary outcome measure was myocardial infarction; secondary outcome measure was inhospital mortality. Logistic regression analysis using generalized estimating equations models and propensity scores compared outcomes. Results: β-Blockers were given in 60 of 348 admissions. The incidence of myocardial infarction after administration of β-blocker was significantly lower than without treatment (6.1% versus 26.0%; difference in proportion 19.9%; 95% confidence interval [CI] 10.3% to 30.0%). One of 14 deaths occurred in patients who received β-blockade (incidence 1.7% versus 4.5% without β-blockade; difference in proportion 2.8%; 95% CI -1.2% to 6.7%). Multivariate analysis showed that use of β-blockers significantly reduced the risk of myocardial infarction (odds ratio 0.06; 95% CI 0.01 to 0.61). Conclusion: In our cohort, administration of β-blockers was associated with reduction in incidence of myocardial infarction after cocaine use. The benefit of β-blockers on myocardial function may offset the risk of coronary artery spasm.

Original languageEnglish (US)
Pages (from-to)117-125
Number of pages9
JournalAnnals of Emergency Medicine
Volume51
Issue number2
DOIs
StatePublished - Feb 2008

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Cocaine
Myocardial Infarction
Spasm
Confidence Intervals
Toxicology
Incidence
Coronary Vessels
Outcome Assessment (Health Care)
Urine
Municipal Hospitals
Telemetry
Propensity Score
Hospital Mortality
Cohort Studies
Multivariate Analysis
Retrospective Studies
Logistic Models
Odds Ratio
Regression Analysis
Safety

ASJC Scopus subject areas

  • Emergency Medicine

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β-Blockers Are Associated With Reduced Risk of Myocardial Infarction After Cocaine Use. / Dattilo, Philip B.; Hailpern, Susan M.; Fearon, Kerrie; Sohal, Davendra; Nordin, Charles W.

In: Annals of Emergency Medicine, Vol. 51, No. 2, 02.2008, p. 117-125.

Research output: Contribution to journalArticle

Dattilo, Philip B. ; Hailpern, Susan M. ; Fearon, Kerrie ; Sohal, Davendra ; Nordin, Charles W. / β-Blockers Are Associated With Reduced Risk of Myocardial Infarction After Cocaine Use. In: Annals of Emergency Medicine. 2008 ; Vol. 51, No. 2. pp. 117-125.
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abstract = "Study objective: β-Blocker use is associated with coronary artery spasm after cocaine administration but also decreases mortality in patients with myocardial infarction or systolic dysfunction. We conduct a retrospective cohort study to analyze the safety of β-blockers in patients with positive urine toxicology results for cocaine. Methods: The cohort consisted of 363 consecutive telemetry and ICU patients who were admitted to a municipal hospital and had positive urine toxicology results for cocaine during a 5-year period (307 patients). Fifteen patients with uncertain history of β-blocker use before admission were excluded. The primary outcome measure was myocardial infarction; secondary outcome measure was inhospital mortality. Logistic regression analysis using generalized estimating equations models and propensity scores compared outcomes. Results: β-Blockers were given in 60 of 348 admissions. The incidence of myocardial infarction after administration of β-blocker was significantly lower than without treatment (6.1{\%} versus 26.0{\%}; difference in proportion 19.9{\%}; 95{\%} confidence interval [CI] 10.3{\%} to 30.0{\%}). One of 14 deaths occurred in patients who received β-blockade (incidence 1.7{\%} versus 4.5{\%} without β-blockade; difference in proportion 2.8{\%}; 95{\%} CI -1.2{\%} to 6.7{\%}). Multivariate analysis showed that use of β-blockers significantly reduced the risk of myocardial infarction (odds ratio 0.06; 95{\%} CI 0.01 to 0.61). Conclusion: In our cohort, administration of β-blockers was associated with reduction in incidence of myocardial infarction after cocaine use. The benefit of β-blockers on myocardial function may offset the risk of coronary artery spasm.",
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