β-Blockers for Chest Pain Associated With Recent Cocaine Use
β-Blockers for Chest Pain Associated With Recent Cocaine Use
复制标题
DOI：
10.1001/archinternmed.2010.115
复制
发表时间：
2010-05-24
影响因子：
--
通讯作者：
Marcus, Gregory M.
中科院分区：
文献类型：
--
作者：
Rangel, Carlos;Shu, Richard G.;Marcus, Gregory M.
背景：虽然β受体阻滞剂可以预防心肌梗塞后的不良事件，但当胸痛与最近使用可卡因有关时，它们是禁忌的。反对使用β受体阻滞剂的建议基于动物研究、小型人体实验和轶事。我们试图检验β受体阻滞剂在这种情况下是安全的假设。方法：我们对加利福尼亚州旧金山总医院收治的连续患者进行了一项回顾性队列研究，这些患者的胸痛和尿液毒理学检测结果对可卡因呈阳性，来自2001 年 1 月至 2006 年 12 月，死亡率数据来自国家死亡指数 结果：在 331 名近期使用可卡因而出现胸痛的患者中，151 名 (46%) 在急诊科接受了 β 受体阻滞剂治疗。两组患者之间的心电图变化、肌钙蛋白水平、住院时间、血管加压药物的使用、插管、室性心动过速或心室颤动或死亡没有显着差异。调整潜在混杂因素后，与在医院病房接受第一种 β 受体阻滞剂的患者相比，在急诊科接受 β 受体阻滞剂的患者的收缩压平均显着降低 8·6 mm Hg（95% 置信区间，14.7-2.5 mm Hg）(P=.006) 中位随访时间为 972 天（四分位数范围， 555-1490 天），调整潜在的混杂因素后，接受 β 受体阻滞剂治疗的患者出院后心血管死亡显着降低（风险比，0.29；95% 置信区间，0.090.98）（P=047）结论：β 受体阻滞剂似乎与近期使用可卡因的胸痛患者的不良事件无关
Background: Although beta-blockers prevent adverse events after myocardial infarction, they are contraindicated when chest pain is associated with recent cocaine use Recommendations against this use of beta-blockers are based on animal studies, small human experiments, and anecdote We sought to test the hypothesis that beta-blockers are safe in this settingMethods: We performed a retrospective cohort study of consecutive patients admitted to the San Francisco General Hospital, San Francisco, California, with chest pain and urine toxicologic test results positive for cocaine, from January 2001 to December 2006 Mortality data were collected from the National Death IndexResults: Of 331 patients with chest pain in the setting of recent cocaine use, 151 (46%) received a beta-blocker in the emergency department There were no meaningful differences in electrocardiographic changes, troponin levels, length of stay, use of vasopressor agents, intubation, ventricular tachycardia or ventricular fibrillation, or death between those who did and did not receive a beta-blocker After adjusting for potential confounders, systolic blood,pressure significantly decreased a mean 8 6 mm Hg (95% confidence interval, 14.7-2.5 mm Hg) in those receiving a beta-blocker in the emergency department compared with those who received their first beta-blocker in the hospital ward(P=.006) Over a median follow-up of 972 days (inter-quartile range, 555-1490 days), after adjusting for potential confounders, patients discharged on beta-blocker regimen exhibited a significant reduction in cardiovascular death (hazard ratio, 0.29; 95% confidence interval, 0.090.98) (P=047)Conclusion: beta-Blockers do not appear to be associated with adverse events in patients with chest pain with recent cocaine use