Beta blockers are indicated for management of
acute coronary syndromes, but they generally are withheld in patients with
cocaine-associated
chest pain because of concerns for adverse outcomes related to the unique physiological effects of
cocaine. Because few clinical studies have evaluated this interaction, we identified patients with toxicology screen results positive for
cocaine treated for
chest pain at 2 academic hospitals. Clinical characteristics and in-hospital outcomes were compared between patients with and without β-blocker
therapy. We then constructed propensity scores to evaluate the independent relation between β-blocker use and the composite primary end point of
myocardial infarction,
stroke, ventricular
arrhythmia, or all-cause mortality after adjusting for clinical characteristics. Of 376 consecutive patients with
cocaine-related
chest pain, β blockers were used in 164 (44%). Compared with no β blockers, patients treated with β blockers were more likely to describe anginal
chest pain, to have known cardiovascular risk factors, and to receive other antiatherosclerotic
therapies. Despite these higher risk clinical characteristics, patients treated with β blockers experienced similar peak
troponin levels, individual adverse events, and rates of the composite primary end point (15.9% vs 12.3%, p = 0.32). The primary end point also was similar after propensity score analysis (odds ratio 1.37, 95% confidence interval 0.64 to 2.93, p = 0.42), including specific comparisons of beta-1 selective (odds ratio 1.83, 95% confidence interval 0.79 to 4.24) and nonselective (odds ratio 0.90, 95% confidence interval 0.33 to 2.42) β blockers, when compared with patients not receiving β blockers. In conclusion, no differences in outcomes were observed between patients treated versus not treated with β-blocker
therapy in the setting of
cocaine-related
chest pain.