Clinical outcomes of chest pain with cocaine use: a propensity score-matched analysis

Authors

Minahil Cheema, University of Maryland School of Medicine, Baltimore, MD, 21201, USA. mcheema@som.umaryland.edu.
Martin Borrisov, Department of Internal Medicine, University of Maryland Medical Center, Midtown Campus, Baltimore, MD, USA.
Ali Pourmand, Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Anastasia Ternovskaia, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.
Daniel Najafali, Carle College of Medicine, University of Illinois Urbana-Champaign, Urbana, IL, USA.
Neeraja Murali, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
Madeline Semler, Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
Rohan Vanga, Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
Roya Tehrani, Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
Quincy K. Tran, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.

Document Type

Journal Article

Publication Date

11-7-2025

Journal

Internal and emergency medicine

DOI

10.1007/s11739-025-04189-7

Keywords

Cardiac arrest; Cardiovascular; Cocaine; Drug use

Abstract

Cocaine use has been linked to cardiovascular complications due to its vasoconstrictive properties; however, short-term risk of major adverse cardiac events (MACE) in patients presenting with chest pain remains controversial due to limited sample sizes (< 5000 patients). Leveraging the TriNetX database, we analyzed 89,652 patients, providing the largest and most statistically powered evaluation of cocaine-associated chest pain to date. This retrospective, propensity score-matched cohort study used the TriNetX Research Network to identify adults presenting to the ED with chest pain or shortness of breath (March 2005-March 2025). Patients undergoing urine toxicology were matched 1:1 into + COCN and -COCN cohorts. The primary outcome was 30-day composite MACE, including acute myocardial infarction (AMI), acute decompensated heart failure (ADHF), ischemic stroke, and cardiac arrest. The matched cohorts included 44,826 patients each. The + COCN group had statistically higher rates of MACE components, though absolute differences were small: AMI (1.25% vs. 0.30%; Risk Difference [RD] 0.002), ADHF (0.17% vs. 0.07%; RD 0.001), and ischemic stroke (0.32% vs. 0.14%; RD 0.002) (all p < 0.001). Cardiac arrest was also more frequent (0.14% vs. 0.09%; p = 0.04). Initial troponin I levels were comparable (+ COCN: 0.3 ± 3.2 ng/mL vs. -COCN: 0.7 ± 4.7 ng/mL, p < 0.001).Cocaine positivity in ED chest pain patients was not associated with a clinically meaningful increase in 30-day MACE. These findings support incorporating + COCN patients into standard, risk-based chest pain pathways rather than reflexive admission or over-testing.

APA Citation

Cheema, Minahil; Borrisov, Martin; Pourmand, Ali; Ternovskaia, Anastasia; Najafali, Daniel; Murali, Neeraja; Semler, Madeline; Vanga, Rohan; Tehrani, Roya; and Tran, Quincy K., "Clinical outcomes of chest pain with cocaine use: a propensity score-matched analysis" (2025). GW Authored Works. Paper 8122.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/8122

Department

Emergency Medicine