Thrombolytic therapy and cocaine-associated acute myocardial infarction

The role of thrombolytic therapy in patients with cocaine-associated acute myocardial infarction (AMI) is controversial. Some have suggested that because the AMI mortality may be low in young patients with cocaine usage, the risks outweigh the benefits of thrombolytic therapy. Two cases of cocaine-associated AMI are presented. Each case illustrates different aspects of this controversy. In one case, ECG interpretation and concerns with thrombolytic therapy in this setting led to prolonged treatment delay. The second case illustrates unrecognized cocaine-associated AMI treated safely with thrombolytic therapy and beta-blockade. The arguments for and against thrombolytic therapy in this setting are discussed. The available literature suggesting increased risk associated with thrombolytic therapy in patients with cocaine-associated AMI is critically reviewed.