Background:
Cocaine-induced chest pain (CICP) is reported in 40% of patients using cocaine and is associated with frequent emergency room visits and hospital admissions.
Hypothesis:
Coronary computed tomographic angiography (CCTA) has better outcomes than standard-of-care (SOC) for the evaluation of patients with CICP.
Method:
CICP patients were randomized to CCTA protocol or SOC. The primary outcome of the study was a composite of recurrent emergency room visits and hospital admissions. Secondary outcomes included length of stay, major adverse cardiovascular events and all-cause mortality.
Results:
The study population consisted of 202 patients with CICP (CCTA=23 and SOC=179). As compared to SOC, the number of emergency room visits in the CCTA group were lower at 30 days (1.04±0.1 vs. 1.24±0.5, p=0.012) and 1 year (2.43±0.9 vs. 2.61±2.1, p=0.008), but not at 3 years (5.04±3.3 vs. 4.87±1, p=0.112) findings that were independent of CCTA results. Mean admission rates for the CCTA group were slightly but not significantly lower than the SOC group at 30 days (0.91±0.1 vs.1.10±0.2 p=0.438) and 1 year (1.52±0.3 vs. 1.82±0.3 p=0.187), but not at 3 years (3.22±0.6 vs. 2.95±0.5, p=0.111). Hospital length of stay was also lower in CCTA patients than in SOC patients (2.61±0.5 vs. 3.34 ± 0.5 p<0.001). After 3 year follow-up, there was 1 major adverse cardiovascular event in the CCTA group compared to 22 in the SOC group (p=0.024). No patient died in the CCTA while 3 patients died from any cause in the SOC group (p=0.776) after 3 years of follow-up.
Conclusion:
In this prospective randomized trial, CCTA reduced near and intermediate-term but not long-term rates of emergency room visits and hospitalizations. When compared to SOC, the use of CCTA was associated with a reduction of major adverse cardiovascular events. Larger randomized controlled trials to further assess the efficacy of a CCTA-based strategy for CICP appear warranted.
The Use of an Accelerated Diagnostic Protocol and a Chest Pain Unit Reduces Length of Stay in Patients with Non-Cardiac Chest Pain