Cocaine-associated myocardial ischemia. Review of clinical and angiographic findings.

The incidence of cocaine use is increasing in the United States among both adolescents and adults. Once thought to be a relatively safe street drug, cocaine has recently been implicated in 12 episodes of myocardial infarction. The case reports of these patients were retrospectively reviewed to determine the clinical and angiographic findings. All 12 patients exhibited electrocardiographic and angiographic evidence of myocardial infarction "shortly after" the use of cocaine by the nasal or intravenous routes. Most of the patients had fixed coronary artery disease. There appears to be increasing evidence of a temporal relationship between the use of cocaine and subsequent myocardial ischemic events in a subgroup of patients with or without fixed coronary artery stenosis. Physicians should inquire about cocaine use in patients with unexplained ischemic episodes since this may represent a potentially reversible factor in the later development of myocardial infarction.