The optimal medical regimen for the treatment of
cocaine associated
myocardial ischemia has not been defined. While animal and human data demonstrate the risks of beta-
adrenergic blockade, studies in the cardiac catheterization laboratory suggest a beneficial role of
nitroglycerin. We performed a prospective multicenter observational study to evaluate the clinical safety and efficacy of
nitroglycerin in the treatment of
cocaine associated
chest pain at six municipal hospital centers. Of 246 patients presenting with
cocaine associated
chest pain, 83 patients were treated with
nitroglycerin at the discretion of the treating physician. Relief of
chest pain and/or adverse hemodynamic outcome were the primary endpoints. Baseline comparisons of patients treated with
nitroglycerin to those not treated with
nitroglycerin found that the treated patients were at higher risk of
ischemic heart disease. They were older (36 years vs 32 years, p = 0.0008), more likely to have an ischemic electrocardiogram (27% vs 4%, p < 0.0001), to be admitted (94% vs 40%, p < 0.0001), and to have a discharge diagnosis of
ischemic heart disease (41% vs 9%, p < 0.0001).
Nitroglycerin was beneficial in 41 patients (49%; 95% CI, 38-60%): 37 patients (45%) had relief or reduction in the severity of
chest pain and 4 patients (5%) had other beneficial effects. Only one patient had an adverse outcome (transient
hypotension in the setting of a right ventricular
infarct).
Nitroglycerin is safe and possibly effective in the treatment of
cocaine associated
chest pain.