Cocaine-associated Chest Pain: Our Experience with Myocardial Markers and Stress Lexiscans

Background: Cocaine is a commonly abused recreational drug, leading to frequent emergency room visits. The aim of this study was to check the effect of cocaine on myocardial markers of injury and the stress myocardial imaging patterns. Methods: All patients with anginal chest pain or equivalents who tested positive for cocaine on urine drug screen with reversible myocardial ischemia on regadenoson stress myocardial perfusion imaging called lexiscans were included and their corresponding myocardial markers of injury and stress imaging were reviewed. Results: Thirty-four patients had tested positive for cocaine in urine, out of the 192 patients with reversible myocardial ischemia on stress testing. The percentage of cocaine-associated myocardial ischemia was up to 17.70% in our study. Creatine kinase-MB levels were above the normal reference value of 5 ng/mL in 72.7% of patients and the combined cardiac troponins by fourth-generation assays were above the detection levels (≥0.02 ng/mL for cardiac troponin I [cTnI] and ≥ 0.010 ng/mL for cardiac troponin T [cTnT]) in 50% of patients. None of our patients had severe reversible myocardial ischemia on lexicans, but rather minimal-to-mild reversible myocardial ischemia was seen in the majority (76.5%) of patients. cTnI elevation was significantly associated with minimal reversible myocardial ischemia on one-way analysis of variance ( P < 0.05). Conclusion: Cocaine was associated with minimal-to-mild reversible myocardial ischemia on stress testing with significant elevation of cTnI.