Self-reported cocaine use, emergency physician testing and outcomes in suspected acute coronary syndromes: a nested matched case–control study
- Yang Wang1,
- Christopher J Lindsell2,
- Charles V Pollack Jr3,
- Judd Hollander4,
- Deborah B Diercks5,
- J Douglas Kirk5,
- Venkataraman Anantharaman6,
- W Brian Gibler2,
- James Hoekstra7,
- W Frank Peacock8
- 1Department of Emergency Services, David Grant Medical Center, Travis Air Force Base, California, USA
- 2College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
- 3Department of Emergency Medicine, Pennsylvania Hospital, Philadelphia, Pennsylvania, USA
- 4Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- 5Department of Emergency Medicine, University of California, Davis Medical Center, Sacramento, California, USA
- 6Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
- 7Department of Emergency Medicine, Wake Forest University Health Sciences, Winston-Salem, North Carolina, USA
- 8Department of Emergency Medicine, Cleveland Clinic, Cleveland, Ohio, USA
- Correspondence to Dr Yang Wang;
- Received 3 November 2011
- Accepted 30 March 2012
- Published 2 June 2012
Objectives The primary purpose was to compare the odds of acute coronary syndrome-pertinent diagnostic testing between self-reported cocaine users and non-users at the turn of the century. The secondary purpose was to compare the odds of acute coronary syndrome outcomes between cocaine users and non-users.
Design Nested matched case–control study using data from the Internet Tracking Registry of Acute Coronary Syndromes.
Setting Extracted data of patients from eight US institutions composed of six academic and two community hospitals, with census varying between 10 000 and 160 000 visits per year.
Participants 249 cases of self-reported cocaine users and 249 matched controls. Matching was based on age, race, sex and any history of known coronary artery disease. Exclusion criteria were new ST elevations on initial ECG and initial physician impression of acute myocardial infarction.
Primary and secondary outcome measures Primary outcome was the conditional odds of undergoing non-invasive and invasive testing for coronary artery disease. Secondary outcome was the occurrences of adverse cardiac outcomes within 30 days.
Results Cocaine users underwent diagnostic testing at similar rates compared with non-users (9.6% vs 8.0%, OR 1.24, CI 0.65 to 2.34). Adverse cardiovascular outcomes occurred in four (1.6%) cocaine users and in seven (2.8%) controls.
Conclusions There was no increase in tendency for testing associated with self-reported history of cocaine use between 1999 and 2001. This suggests that even 10 years ago, cocaine use already had only a limited role in the Emergency Department (ED) physician's decision-making process. Similar data analyses of detailed registries can offer important contextual information that can better direct resources for future comparative effectiveness research.
To cite: Wang Y, Lindsell CJ, Pollack CV Jr, et al. Self-reported cocaine use, emergency physician testing, and outcomes in suspected acute coronary syndromes: a nested, matched case-control study. BMJ Open 2012;2:e000572. doi:10.1136/bmjopen-2011-000572
Contributors YW, CJL and WFP were involved in the conception and design, acquisition of data and analysis and interpretation of data; YW and WFP were involved in drafting the article; all authors were involved in critical revisions for important intellectual content and have given final approval of the version to be published.
Funding Although this research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors, the initial I*trACS registry was supported by a grant in part by Millenium Pharmaceuticals and Schering-Plough Pharmaceuticals.
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement There are no additional data available for this study.
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