Kevin Bryan Lo1, Hafeez Ul Hassan Virk2, Vladimir Lakhter3, Pradhum Ram4, Carlos Gongora5, Gregg Pressman2, Vincent Figueredo2. 1. Department of Medicine. Electronic address: lokevinb@einstein.edu. 2. Department of Cardiology, Albert Einstein Medical Center, Philadelphia, Pa. 3. Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston. 4. Department of Medicine. 5. Department of Cardiology, Mount Sinai St. Lukes West Hospital, New York, NY.
Abstract
BACKGROUND: Recent guidelines have suggested avoiding beta-blockers in the setting of cocaine-associated acute coronary syndrome. However, the available evidence is both scarce and conflicted. The purpose of this systematic review and meta-analysis is to investigate the evidence pertaining to the use of beta-blockers in the setting of acute cocaine-related chest pain and its implication on clinical outcomes. METHODS: Electronic databases were systematically searched to identify literature relevant to patients with cocaine-associated chest pain who were treated with or without beta-blockers. We examined the end-points of in-hospital all-cause mortality and myocardial infarction. Pooled risk ratios (RR) and their 95% confidence intervals (CI) were calculated for all outcomes using a random-effects model. RESULTS: Five studies with a total of 1447 patients were included. Our analyses found no differences between patients treated with or without beta-blockers for either myocardial infarction (RR 1.08; 95% CI, 0.61-1.91) or all-cause mortality (RR 0.75; 95% CI, 0.46-1.24). Heterogeneity among included studies was low to moderate. CONCLUSION: This systematic review and meta-analysis suggests that beta-blocker use is not associated with adverse clinical outcomes in patients presenting with acute chest pain related to cocaine use.
BACKGROUND: Recent guidelines have suggested avoiding beta-blockers in the setting of cocaine-associated acute coronary syndrome. However, the available evidence is both scarce and conflicted. The purpose of this systematic review and meta-analysis is to investigate the evidence pertaining to the use of beta-blockers in the setting of acute cocaine-related chest pain and its implication on clinical outcomes. METHODS: Electronic databases were systematically searched to identify literature relevant to patients with cocaine-associated chest pain who were treated with or without beta-blockers. We examined the end-points of in-hospital all-cause mortality and myocardial infarction. Pooled risk ratios (RR) and their 95% confidence intervals (CI) were calculated for all outcomes using a random-effects model. RESULTS: Five studies with a total of 1447 patients were included. Our analyses found no differences between patients treated with or without beta-blockers for either myocardial infarction (RR 1.08; 95% CI, 0.61-1.91) or all-cause mortality (RR 0.75; 95% CI, 0.46-1.24). Heterogeneity among included studies was low to moderate. CONCLUSION: This systematic review and meta-analysis suggests that beta-blocker use is not associated with adverse clinical outcomes in patients presenting with acute chest pain related to cocaine use.
Authors: Paari Dominic; Javaria Ahmad; Hajra Awwab; Md Shenuarin Bhuiyan; Christopher G Kevil; Nicholas E Goeders; Kevin S Murnane; James C Patterson; Kristin E Sandau; Rakesh Gopinathannair; Brian Olshansky Journal: Circ Arrhythm Electrophysiol Date: 2021-12-28