Predictors of underlying coronary artery disease in cocaine associated myocardial infarction: a meta-analysis of case reports.

Age, number of cardiac risk factors, inferior infarction and bradyarrhythmias predicted underlying coronary artery disease (CAD) in patients with cocaine associated myocardial infarction. We sought to validate these criteria through a meta-analysis of published case reports. Cocaine associated myocardial infarctions reported in the English language literature were retrospectively identified. Data abstracted included patient demographics; cardiac risk factors, history of myocardial infarctions, last use of cocaine and complications during hospital course, and the presence or absence of CAD. Patients with CAD (> 50% stenosis on cardiac catheterization or autopsy) were compared to patients without CAD (normal coronaries of cardiac catheterization). In all cases of incomplete information, the authors were contacted for missing results. We identified 66 patients with cocaine associated myocardial infarction in whom the presence or absence of CAD was known: 41% had CAD. Of the 27 patients with CAD, 14 (52%) had 1 vessel disease, 7 (26%) had 2 vessel and 6 (22%) had 3 vessel disease. CAD was associated with the presence of 2 or more cardiac risk factors (18% vs 0%, p = 0.03), however the sensitivity for detection of CAD was only 18%. Bradyarrhythmias were uncommon but only occurred in patients with CAD (8% vs 0%, p = 0.17), however the sensitivity for detection of CAD was only 8%. Patients with and without CAD did not differ in terms of the other criteria (age > 40 y and infarct location) previously found associated with a higher likelihood of CAD. In this meta-analysis of published case reports, patients with cocaine associated myocardial infarction and 2 or more traditional cardiac risk factors were more likely to have underlying CAD, but only 18% of patients with underlying CAD would be detected through this screening criteria. Larger prospective trials are needed to better determine criteria predictive of underlying CAD in patients with cocaine associated myocardial infarction.