Abstract 11012: Safety of Beta-Blocker Use in Cocaine-Associated Chest Pain: A Meta-Analysis of 1,794 Patients
Background: Beta-Blockers (BB) have been an established therapy in acute coronary syndrome. Due to the risk of unopposed α-adrenergic stimulation and coronary vasospasm in patients with cocaine-associated chest pain (CACP), their use in this population remains controversial. Few studies exist addressing the role of BB in CACP.
Methods: A comprehensive literature search using PubMed (MEDLINE) and EMBASE was performed using keywords “beta blocker” and “cocaine.” The publications were filtered for either retrospective or prospective studies that included CACP patients with or without BB. Outcomes of interest included non-fatal myocardial infarction (MI) and all-cause mortality. Of 580 identified abstracts, 5 studies met the inclusion criteria (1,794 patients). Data on baseline characteristics and outcomes of interest were extracted. Meta-analysis was performed using Review Manager Version 5.0 (Cochrane Collaboration). Effect sizes for outcomes of interest were estimated using odds ratio (OR) and 95% confidence intervals (CI). Given the inherent heterogeneity in the data, results from the random effects model were reported.
Results: Five trials (n=1,756) reported on MI in CACP with no significant difference between patients on BB vs. no BB (OR 1.36, 95% CI 0.68-2.75, p = 0.39, I2 = 71%). Three trials (n=1,014) reported on all-cause mortality with no significant difference in all-cause mortality in patients on BB vs. no BB (OR 0.17, 95% CI 0.01-4.74, p = 0.30, I2=86%).
Conclusion: This is the first meta-analysis to examine the impact of BB in patients with CACP. Our results indicate that BB use was not associated with an increased risk of MI or all-cause mortality. These findings are of clinical significance given lower use of BB (a guideline-driven therapy) in CACP, and underlines the paucity of data plus need for additional clinical studies in this area.
Author Disclosures: D. Pham: None. W. Kayani: None. D. Addison: None. A. Misra: None. H. Jneid: None. N. Lakkis: None. M. Alam: None.
- © 2014 by American Heart Association, Inc.