RT Journal
A1 Rangel C, Shu RG, Lazar LD, Vittinghoff E, Hsue PY, Marcus GM
T1 Β-blockers for chest pain associated with recent cocaine use
JF Archives of Internal Medicine
JO Archives of Internal Medicine
YR 2010
FD May 24
VO 170
IS 10
SP 874
OP 879
DO 10.1001/archinternmed.2010.115
UL http://dx.doi.org/10.1001/archinternmed.2010.115
AB Background 
    Although β-blockers prevent adverse events after myocardial infarction, they are contraindicated when chest pain is associated with recent cocaine use. Recommendations against this use of β-blockers are based on animal studies, small human experiments, and anecdote. We sought to test the hypothesis that β-blockers are safe in this setting.Methods 
    We performed a retrospective cohort study of consecutive patients admitted to the San Francisco General Hospital, San Francisco, California, with chest pain and urine toxicologic test results positive for cocaine, from January 2001 to December 2006. Mortality data were collected from the National Death Index.Results 
    Of 331 patients with chest pain in the setting of recent cocaine use, 151 (46%) received a β-blocker in the emergency department. There were no meaningful differences in electrocardiographic changes, troponin levels, length of stay, use of vasopressor agents, intubation, ventricular tachycardia or ventricular fibrillation, or death between those who did and did not receive a β-blocker. After adjusting for potential confounders, systolic blood pressure significantly decreased a mean 8.6 mm Hg (95% confidence interval, 14.7-2.5 mm Hg) in those receiving a β-blocker in the emergency department compared with those who received their first β-blocker in the hospital ward (P = .006). Over a median follow-up of 972 days (interquartile range, 555-1490 days), after adjusting for potential confounders, patients discharged on a β-blocker regimen exhibited a significant reduction in cardiovascular death (hazard ratio, 0.29; 95% confidence interval, 0.09-0.98) (P = .047).Conclusion 
    β-Blockers do not appear to be associated with adverse events in patients with chest pain with recent cocaine use.