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Mortality and Complications

Judd E. Hollander, MD; Robert S. Hoffman, MD; Jonathan L. Burstein, MD; Richard D. Shih, MD; Henry C. Thode, Jr, PhD; Cocaine-Associated Myocardial Infarction Study Group; Joel Bartfield, MD; Nancy Raccio-Robak, RN; Fred Harchelroad, MD; Robert S. Hoffman, MD; Richard D. Shih, MD; Lewis Nelson, MD; Marcelo Sandoval, MD; James Feldman, MD; Susan Fish, PharmD, MPH; Wallace Carter, MD; Ronald Paynter, MD; Chris Whelan, MD; Robert Silverman, MD; Kenneth Scheppke, MD; Hilary Thomaser, MD; Suzanne Doyon, MD; Paul Wax, MD; Bernard L. Lopez, MD; Lewis Nelson, MD; Richard D. Shih, MD; Joseph Imbesi, MD; Laura Giroski, DO; Judd E. Hollander, MD; Jonathan Burstein, MD; Suzanne M. Shepherd, MD; Mary Sparkes, MD; Donna Seger, MD; Robert J. Goetz, PharmD; David L. Morgan, MD; Ginger Wilhelm, MD; David Schumb, MD; Karl A. Sporer, MD; Brian Sutton, MD; Louis J. Ling, MD; Lance Wilson, MD; James Hoekstra, MD; Ken Kulig, MD; Scott Phillips, MD; Jeffrey Brent, MD; Ken Kulig, MD; Scott Phillips, MD; Jeffrey Brent, MD; William A. Watson, PharmD; Annette M. Quick, MD; Judd E. Hollander, MD; Robert S. Hoffman, MD; Henry C. Thodejr, PhD; Judd E. Hollander, MD; Robert S. Hoffman, MD; Jonathan Burstein, MD; Richard D. Shih, MD; Henry C. Thode, Jr, PhD

Arch Intern Med. 1995;155(10):1081-1086.

Abstract
Background
The frequency of complications in patients with cocaine-associated myocardial infarction is unknown. This study was performed to determine the short-term morbidity and mortality secondary to cocaine-associated myocardial infarction.

Methods
We performed a retrospective cohort study at 29 hospital centers throughout the United States. Patients with cocaine-associated myocardial infarction that occurred between 1987 and 1993 were identified through record review. The primary outcome measures were inhospital mortality and the incidence and timing of major cardiovascular complications.

Results
Cocaine-associated myocardial infarction was identified 136 times in 130 patients. Patients were generally young (mean age, 38 years), nonwhite (72%), tobacco smokers (91%) with a history of cocaine use in the past 24 hours (88%). The initial electrocardiogram disclosed infarction in 44% and ischemia in an additional 18% of patients. Myocardial infarctions were evenly distributed between anterior (45%) and inferior (44%) and were most often non—Q-wave (61%). Complications occurred 64 times in 49 patients (36%; 95% confidence interval, 28% to 44%), including congestive heart failure in nine patients, ventricular tachycardia in 23 patients, supraventricular tachycardia in six patients, and brady-dysrhythmias in 26 patients. Most patients who had complications (90%) had them within 12 hours of presentation. Acute in-hospital mortality was 0% (95% confidence interval, 0% to 2%).

Conclusions
The mortality of patients hospitalized with cocaine-associated myocardial infarction was low. The majority of complications occurred within 12 hours of presentation.

(Arch Intern Med. 1995;155:1081-1086)

Author Affiliations
Albany (NY) Medical Center; Allegheny General Hospital, Pittsburgh, Pa; Bellevue Hospital Center, New York, NY; Beth Israel Medical Center, New York, NY; Boston (Mass) City Hospital; Bronx (NY) Municipal Hospital Center; Brookhaven Memorial Hospital Medical Center, East Patchogue, NY; Long Island Jewish Medical Center, New Hyde Park, NY; Medical Center of Delaware, Wilmington; Metropolitan Hospital, New York; Misericordia Hospital, Philadelphia, Pa; Strong Memorial Hospital, Rochester, NY; Thomas Jefferson University Hospital, Philadelphia; Tisch Hospital, New York; Union (NJ) Hospital; University Medical Center, Stony Brook, NY; Southeast University of Florida Health Sciences Center, Jacksonville; Vanderbilt University Medical Center, Memphis, Tenn; Southwest Southwestern Medical Center, Dallas, Tex; University of Texas Medical Center at Houston; Northwest Highland General Hospital, Oakland, Calif; San Francisco (Calif) General Hospital; Valley Medical Center, Fresno, Calif; Midwest Hennepin County Medical Center, Minneapolis, Minn; Mount Sinai Medical Center, Cleveland, Ohio; Ohio State University Medical Center, Columbus; Porter Memorial Hospital, Denver, Colo; Swedish Medical Center, Englewood, Colo; University of Missouri, Kansas City; Data Analysis and Statistical Consultant; Manuscript Preparation Committee

From the Department of Emergency Medicine, University Medical Center, Stony Brook, NY (Drs Hollander, Burstein, and Thode); and New York City Poison Control Center, New York, NY (Drs Hoffman and Shih). Members of the Cocaine-Associated Myocardial Infarction Study Group are listed in a box on p 1086.

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