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Ann Emerg Med. 1999 Jun;33(6):639-45.

Myocardial perfusion imaging with technetium-99m sestamibi in patients with cocaine-associated chest pain.

Author information

1
Department of Internal Medicine, Division of Cardiology, Department of Emergency Medicine, Medical College of Virginia/Virginia Commonwealth University, Richmond, VA, USA.

Abstract

STUDY OBJECTIVE:

To describe the characteristics and outcome in patients presenting to the emergency department with chest pain associated with cocaine use, the majority of whom underwent early rest perfusion imaging.

METHODS:

From January 1994 to June 1996, 218 patients had 241 ED visits for evaluation of symptoms consistent with myocardial ischemia after cocaine use. High-risk patients (N=25) were admitted directly to the CCU for exclusion of myocardial infarction (MI). Moderate- to low-risk patients (N=216) were promptly injected with technetium-99m sestamibi in the ED and underwent gated myocardial perfusion imaging 60 to 90 minutes later. Moderate-risk patients were observed in the CCU, whereas low-risk patients with negative perfusion imaging results were discharged home directly from the ED.

RESULTS:

A diagnosis of MI was made in 6 patients, 4 of whom had ECG findings consistent with MI. Of the 216 patients who underwent perfusion imaging, 5 had positive study results, including 2 with MI. None of the 38 patients with negative results after perfusion imaging who were admitted to the CCU had a diagnosis of MI. Only 6 of the 67 patients undergoing stress perfusion imaging had reversible perfusion defects. At 30-day follow-up, there were no cardiac events in patients with negative results after rest perfusion imaging.

CONCLUSION:

Acute MI is infrequent in patients presenting with cocaine-associated chest pain. Positive results after rest perfusion imaging are uncommon, suggesting that myocardial ischemia is infrequently the cause of cocaine-associated chest pain. Early perfusion imaging may offer an effective alternative to routine CCU admission of patients with cocaine-related cardiac symptoms.

PMID:
10339678
[Indexed for MEDLINE]

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