The Effects of Carvedilol in Patients with Cocaine-Induced Chest Pain

Purpose: Benefits of beta-blocker therapy in acute coronary syndromes are well documented although their use in patients with cocaine-induced chest pain (CICP) remains controversial due to concerns regarding unopposed alpha-receptor vasoconstriction. Many patients presenting with CICP have compelling indications for beta-blockade, and carvedilol is often used because of its alpha-blocking properties. The purpose of this study is to determine safety and efficacy outcomes after carvedilol prescription to veterans after CICP. 

Methods: A retrospective analysis of patients presenting with chest pain and positive urine drug screen for cocaine over 72 months was performed. Demographic data, discharge beta-blocker prescription, concomitant diseases, emergency care, length of stay, all cause emergency department and readmission rates, recurrent MI, and mortality were evaluated. Outcomes were compared between patients receiving carvedilol and those receiving no beta-blocker in this initial analysis. 

Results: A total of 909 occurrences were identified and outcomes in the first 76 cases meeting inclusion criteria are reported.  Beta-blockers were prescribed at discharge in 25 (33%) cases, with carvedilol prescribed in 16 (64%). Patients discharged on carvedilol were significantly older and were more likely to have hypertension, heart failure, or coronary artery disease compared to patients receiving no beta-blocker. No significant differences in emergency care, length of stay, all cause emergency department and readmission rates, recurrent MI, and mortality were found between those receiving carvedilol compared to no beta-blocker. In patients with ejection fraction <40%, there were no differences in outcomes between patients receiving carvedilol and those prescribed no beta-blocker. 

Conclusion: Patients with indications for beta-blocker therapy were more likely to be prescribed carvedilol at discharge, despite cocaine use. Prescription of carvedilol to patients after CICP did not appear to worsen outcomes. Carvedilol use in patients with ejection fraction <40% and CICP was safe.