Management of cocaine-induced myocardial infarction: 4-year experience at an urban medical center

Abednego Chibungu, Venkat Gundareddy, Scott Wright, Chike Nwabuo, Preetam Bollampally, Regina Landis, Shaker M Eid

Research output: Contribution to journalArticle

Abstract

Objectives In 2008, the American Heart Association and the American College of Cardiology released guidelines for the management of cocaine-induced myocardial infarction (CIMI). We hypothesized that CIMI patients are likely to receive less invasive and more conservative management than patients with MI without history of cocaine use. Methods We conducted a retrospective analysis on patients younger than 65 years presenting with acute MI between April 1, 2008 and December 31, 2012. Patients were classified as cocaine-negative MI or CIMI based on either urine toxicology results or self-reported cocaine use. Categorical and continuous variables were compared using χ2 or t test as appropriate. The primary outcome was cardiac catheterization or stress testing. The secondary outcome was a 30-day readmission rate for major adverse cardiovascular events. Multiple logistic regression models calculated odds ratios (ORs) for the primary outcomes adjusting for patient demographics and comorbidities. Results Of 378 MI patients, 4.2 % had CIMI. CIMI patients were younger (50 vs 54 years; P <0.01) predominantly African American (56% vs 16%, P <0.01), and mostly active smokers (88% vs 58%, P = 0.02). They were more likely to receive stress testing (adjusted OR 3.61, 95% confidence interval 1.04-12.53) and less likely to undergo cardiac catheterization (adjusted OR 0.12, 95% confidence interval 0.03-0.45). The 30-day readmission rate for major adverse cardiovascular events was higher in CIMI compared with cocaine-negative MI patients (38% vs 13%; P = 0.03). Conclusions The use of cocaine in patients presenting with acute MI appears to impact management decisions of providers. Patient-centered postdischarge arrangements need better coordination for this patient group to optimize their follow-up care.

Original languageEnglish (US)
Pages (from-to)185-190
Number of pages6
JournalSouthern Medical Journal
Volume109
Issue number3
DOIs
StatePublished - Mar 1 2016

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Cocaine
Myocardial Infarction
Odds Ratio
Cardiac Catheterization
Logistic Models
Confidence Intervals
Aftercare
African Americans
Toxicology
Comorbidity
Demography
Urine
Guidelines

Keywords

  • cocaine
  • disparities
  • myocardial infarction
  • non-ST segment elevation myocardial infarction
  • ST segment elevation myocardial infarction

ASJC Scopus subject areas

  • Medicine(all)

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Management of cocaine-induced myocardial infarction : 4-year experience at an urban medical center. / Chibungu, Abednego; Gundareddy, Venkat; Wright, Scott; Nwabuo, Chike; Bollampally, Preetam; Landis, Regina; Eid, Shaker M.

In: Southern Medical Journal, Vol. 109, No. 3, 01.03.2016, p. 185-190.

Research output: Contribution to journalArticle

Chibungu, Abednego ; Gundareddy, Venkat ; Wright, Scott ; Nwabuo, Chike ; Bollampally, Preetam ; Landis, Regina ; Eid, Shaker M. / Management of cocaine-induced myocardial infarction : 4-year experience at an urban medical center. In: Southern Medical Journal. 2016 ; Vol. 109, No. 3. pp. 185-190.
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abstract = "Objectives In 2008, the American Heart Association and the American College of Cardiology released guidelines for the management of cocaine-induced myocardial infarction (CIMI). We hypothesized that CIMI patients are likely to receive less invasive and more conservative management than patients with MI without history of cocaine use. Methods We conducted a retrospective analysis on patients younger than 65 years presenting with acute MI between April 1, 2008 and December 31, 2012. Patients were classified as cocaine-negative MI or CIMI based on either urine toxicology results or self-reported cocaine use. Categorical and continuous variables were compared using χ2 or t test as appropriate. The primary outcome was cardiac catheterization or stress testing. The secondary outcome was a 30-day readmission rate for major adverse cardiovascular events. Multiple logistic regression models calculated odds ratios (ORs) for the primary outcomes adjusting for patient demographics and comorbidities. Results Of 378 MI patients, 4.2 {\%} had CIMI. CIMI patients were younger (50 vs 54 years; P <0.01) predominantly African American (56{\%} vs 16{\%}, P <0.01), and mostly active smokers (88{\%} vs 58{\%}, P = 0.02). They were more likely to receive stress testing (adjusted OR 3.61, 95{\%} confidence interval 1.04-12.53) and less likely to undergo cardiac catheterization (adjusted OR 0.12, 95{\%} confidence interval 0.03-0.45). The 30-day readmission rate for major adverse cardiovascular events was higher in CIMI compared with cocaine-negative MI patients (38{\%} vs 13{\%}; P = 0.03). Conclusions The use of cocaine in patients presenting with acute MI appears to impact management decisions of providers. Patient-centered postdischarge arrangements need better coordination for this patient group to optimize their follow-up care.",
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N2 - Objectives In 2008, the American Heart Association and the American College of Cardiology released guidelines for the management of cocaine-induced myocardial infarction (CIMI). We hypothesized that CIMI patients are likely to receive less invasive and more conservative management than patients with MI without history of cocaine use. Methods We conducted a retrospective analysis on patients younger than 65 years presenting with acute MI between April 1, 2008 and December 31, 2012. Patients were classified as cocaine-negative MI or CIMI based on either urine toxicology results or self-reported cocaine use. Categorical and continuous variables were compared using χ2 or t test as appropriate. The primary outcome was cardiac catheterization or stress testing. The secondary outcome was a 30-day readmission rate for major adverse cardiovascular events. Multiple logistic regression models calculated odds ratios (ORs) for the primary outcomes adjusting for patient demographics and comorbidities. Results Of 378 MI patients, 4.2 % had CIMI. CIMI patients were younger (50 vs 54 years; P <0.01) predominantly African American (56% vs 16%, P <0.01), and mostly active smokers (88% vs 58%, P = 0.02). They were more likely to receive stress testing (adjusted OR 3.61, 95% confidence interval 1.04-12.53) and less likely to undergo cardiac catheterization (adjusted OR 0.12, 95% confidence interval 0.03-0.45). The 30-day readmission rate for major adverse cardiovascular events was higher in CIMI compared with cocaine-negative MI patients (38% vs 13%; P = 0.03). Conclusions The use of cocaine in patients presenting with acute MI appears to impact management decisions of providers. Patient-centered postdischarge arrangements need better coordination for this patient group to optimize their follow-up care.

AB - Objectives In 2008, the American Heart Association and the American College of Cardiology released guidelines for the management of cocaine-induced myocardial infarction (CIMI). We hypothesized that CIMI patients are likely to receive less invasive and more conservative management than patients with MI without history of cocaine use. Methods We conducted a retrospective analysis on patients younger than 65 years presenting with acute MI between April 1, 2008 and December 31, 2012. Patients were classified as cocaine-negative MI or CIMI based on either urine toxicology results or self-reported cocaine use. Categorical and continuous variables were compared using χ2 or t test as appropriate. The primary outcome was cardiac catheterization or stress testing. The secondary outcome was a 30-day readmission rate for major adverse cardiovascular events. Multiple logistic regression models calculated odds ratios (ORs) for the primary outcomes adjusting for patient demographics and comorbidities. Results Of 378 MI patients, 4.2 % had CIMI. CIMI patients were younger (50 vs 54 years; P <0.01) predominantly African American (56% vs 16%, P <0.01), and mostly active smokers (88% vs 58%, P = 0.02). They were more likely to receive stress testing (adjusted OR 3.61, 95% confidence interval 1.04-12.53) and less likely to undergo cardiac catheterization (adjusted OR 0.12, 95% confidence interval 0.03-0.45). The 30-day readmission rate for major adverse cardiovascular events was higher in CIMI compared with cocaine-negative MI patients (38% vs 13%; P = 0.03). Conclusions The use of cocaine in patients presenting with acute MI appears to impact management decisions of providers. Patient-centered postdischarge arrangements need better coordination for this patient group to optimize their follow-up care.

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KW - disparities

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