Myocardial perfusion imaging with technetium-99m sestamibi in patients with cocaine-associated chest pain

To describe the characteristics and outcome in patients presenting to the emergency department with chest pain associated with cocaine use, the majority of whom underwent early rest perfusion imaging.

From January 1994 to June 1996, 218 patients had 241 ED visits for evaluation of symptoms consistent with myocardial ischemia after cocaine use. High-risk patients (N=25) were admitted directly to the CCU for exclusion of myocardial infarction (MI). Moderate- to low-risk patients (N=216) were promptly injected with technetium-99m sestamibi in the ED and underwent gated myocardial perfusion imaging 60 to 90 minutes later. Moderate-risk patients were observed in the CCU, whereas low-risk patients with negative perfusion imaging results were discharged home directly from the ED.

A diagnosis of MI was made in 6 patients, 4 of whom had ECG findings consistent with MI. Of the 216 patients who underwent perfusion imaging, 5 had positive study results, including 2 with MI. None of the 38 patients with negative results after perfusion imaging who were admitted to the CCU had a diagnosis of MI. Only 6 of the 67 patients undergoing stress perfusion imaging had reversible perfusion defects. At 30-day follow-up, there were no cardiac events in patients with negative results after rest perfusion imaging.

Acute MI is infrequent in patients presenting with cocaine-associated chest pain. Positive results after rest perfusion imaging are uncommon, suggesting that myocardial ischemia is infrequently the cause of cocaine-associated chest pain. Early perfusion imaging may offer an effective alternative to routine CCU admission of patients with cocaine-related cardiac symptoms.