Hospital Admissions for Chest Pain Associated with Cocaine Use in the United States

Vikas Singh, Alex P. Rodriguez, Badal Thakkar, Ghanshyambhai T. Savani, Nileshkumar J. Patel, Apurva O. Badheka, Mauricio G. Cohen, Carlos E. Alfonso, Raul D. Mitrani, Juan Viles-Gonzalez, Jeffrey J. Goldberger

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Background The outcomes related to chest pain associated with cocaine use and its burden on the healthcare system are not well studied. Methods Data were collected from the Nationwide Inpatient Sample (2001-2012). Subjects were identified by using the International Classification of Diseases, Ninth Revision, Clinical Modification codes. Primary outcome was a composite of mortality, myocardial infarction, stroke, and cardiac arrest. Results We identified 363,143 admissions for cocaine-induced chest pain. Mean age was 44.9 (±21.1) years with male predominance. Left heart catheterizations were performed in 6.7%, whereas the frequency of acute myocardial infarction and percutaneous coronary interventions were 0.69% and 0.22%, respectively. The in-hospital mortality was 0.09%, and the primary outcome occurred in 1.19% of patients. Statistically significant predictors of primary outcome included female sex (odds ratio [OR], 1.16; confidence interval [CI], 1.00-1.35; P =.046), age >50 years (OR, 1.24, CI, 1.07-1.43; P =.004), history of heart failure (OR, 1.63, CI, 1.37-1.93; P <.001), supraventricular tachycardia (OR, 2.94, CI, 1.34-6.42; P =.007), endocarditis (OR, 3.5, CI, 1.50-8.18, P =.004), tobacco use (OR, 1.3, CI, 1.13-1.49; P <.001), dyslipidemia (OR, 1.5, CI, 1.29-1.77; P <.001), coronary artery disease (OR, 2.37, CI, 2.03-2.76; P <.001), and renal failure (OR, 1.27, CI, 1.08-1.50; P =.005). The total annual projected economic burden ranged from $155 to $226 million with a cumulative accruement of more than $2 billion over a decade. Conclusion Hospital admissions due to chest pain and concomitant cocaine use are associated with low rates of adverse outcomes. For the low-risk cohort in whom acute coronary syndrome has been ruled out, hospitalization may not be beneficial and may result in unnecessary cardiac procedures.

Original languageEnglish (US)
Pages (from-to)688-698
Number of pages11
JournalAmerican Journal of Medicine
Issue number6
StatePublished - Jun 2017
Externally publishedYes


  • Chest pain
  • Cocaine use
  • Mortality
  • Myocardial infarction
  • Percutaneous coronary intervention

ASJC Scopus subject areas

  • Medicine(all)


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