Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website http://www.cardiologyres.org

Original Article

Volume 10, Number 1, February 2019, pages 40-47

In-Hospital and Long-Term Outcomes of Beta-Blocker Treatment in Cocaine Users: A Systematic Review and Meta-analysis

Figure 2. In-hospital all-cause death and myocardial infarction (MI) (or myocardial necrosis) in patients with cocaine-associated chest pain who did and did not received beta-blocker treatment. BB: beta-blocker; RR: relative risk; CI: confidence interval. *Weights are from random effects analysis.

Figure 3. Long-term all-cause death and myocardial infarction (MI) in patients with cocaine-associated chest pain or recent cocaine use who did and did not received beta-blocker treatment. BB: beta-blocker; RR: relative risk; CI: confidence interval. *Weights are from random effects analysis.

**Table 1.** Characteristics of Included Studies
Study	Design	Period	Age, yrs^{a, b}	Female, %^b	Follow-up	Number of cases/total patients
BB: β-blocker; MI: myocardial infarction; MN: myocardial necrosis; NA: not available; P: prospective; R: retrospective; Yr: year. ^aMean or median values; ^bBB user/non-user; ^cOnly overall population number is available.
Mohamad et al [23]	R	2004 - 2005	47^c	27^c	In-hospital	14/100	13/254	NA	NA	NA	NA	NA	NA
Dattilo et al [14]	R	2000 - 2005	50/44	27/37	In-hospital	2/33	72/277	NA	NA	1/33	13/277	NA	NA
Rangel et al [15]	R	2001 - 2006	51/48	26/29	2.7 yrs	15/151	18/177	NA	NA	2/151	3/177	18/149	27/168
Ibrahim et al [17]	R	1998 - 2011	46/42	23/25	In-hospital	22/162	20/216	NA	NA	NA	NA	NA	NA
Fanari et al [16]	R	2000 - 2007	46/42	32/26	In-hospital	5/164	2/212	NA	NA	3/164	6/212	NA	NA
Schmidt et al [24]	R	2006 - 2009	50/48	12/6	In-hospital	14/26	17/32	NA	NA	0/26	0/32	NA	NA
Finks et al [25]	R	NA	57/54	NA	1 yr	NA	NA	2/47	5/140	NA	NA	6/47	14/140
Cediel et al [18]	P	2001 - 2014	45/43	13/6	4 yrs	NA	NA	6/33	5/24	0/33	2/24	2/33	5/24

Table 1. Characteristics of Included Studies

Study

Design

Period

Age, yrs^{a, b}

Female, %^b

Follow-up

Number of cases/total patients

In-hospital MI or MN

Long-term MI

In-hospital death

Long-term death

BB user

Non-user

BB user

Non-user

BB user

Non-user

BB user

Non-user

BB: β-blocker; MI: myocardial infarction; MN: myocardial necrosis; NA: not available; P: prospective; R: retrospective; Yr: year. ^aMean or median values; ^bBB user/non-user; ^cOnly overall population number is available.

Mohamad et al [23]

2004 - 2005

47^c

27^c

In-hospital

14/100

13/254

Dattilo et al [14]

2000 - 2005

50/44

27/37

In-hospital

2/33

72/277

1/33

13/277

Rangel et al [15]

2001 - 2006

51/48

26/29

2.7 yrs

15/151

18/177

2/151

3/177

18/149

27/168

Ibrahim et al [17]

1998 - 2011

46/42

23/25

In-hospital

22/162

20/216

Fanari et al [16]

2000 - 2007

46/42

32/26

In-hospital

5/164

2/212

3/164

6/212

Schmidt et al [24]

2006 - 2009

50/48

12/6

In-hospital

14/26

17/32

0/26

0/32

Finks et al [25]

57/54

1 yr

2/47

5/140

6/47

14/140

Cediel et al [18]

2001 - 2014

45/43

13/6

4 yrs

6/33

5/24

0/33

2/24

2/33

5/24

**Table 2.** Definitions, Types of β-Blocker, and Timing of Administration
Study	Symptoms on presentation	Definition of cocaine use	MI definition	Type of BB	Timing of BB administration
BB: β-blocker; ECG: electrocardiogram; ED: emergency department; NA: not available; MI: myocardial infarction; UDS: urine drug screening; IV: intravenous.
Mohamad et al [23]	Chest pain	Positive UDS	MI (or myocardial necrosis): chest pain and troponin I > 0.02 ng/mL	Not specified	On presentation
Dattilo et al [14]	47% chest pain; 2% heart failure; 3% stroke; 3% seizure; 4% overdose	Positive UDS	Troponin I > 0.10 ng/mL or ECG changes ≥ two contiguous leads	66% metoprolol, atenolol, or propranolol; 21% labetalol or carvedilol; 13% both	During admission
Rangel et al [15]	Chest pain	Positive UDS	Troponin > 1.5 ng/mL	74% IV metoprolol; 11% oral metoprolol; 12% IV labetalol; 2% oral labetalol; 1% oral atenolol; 1% oral propranolol	In the ED
Ibrahim et al [17]	Chest pain	Positive UDS and reported cocaine use within the previous 24 h	Troponin I > 0.6 ng/mL and Troponin T > 0.1 ng/mL	53% metoprolol; 27.2% labetalol; 26.6% carvedilol; 2% atenolol	During admission
Fanari et al [16]	Chest pain	Positive UDS and reported cocaine use within the previous 24 h	Troponin T > 0.1 ng/dL or ST-segment elevations in two contiguous leads in ECG	20% metoprolol; 12% labetalol; 11% carvedilol; 1% atenolol	During admission (within the first 24 h)
Schmidt et al [24]	Chest pain	Positive UDS	Positive troponin	50% oral metoprolol; 19% IV metoprolol; 8% IV labetalol; 8% oral carvedilol; 8% oral atenolol; 8% oral propranolol	During admission (while having chest pain) or at discharge
Finks et al [25]	Chest pain	Positive UDS	NA	100% carvedilol	At discharge
Cediel et al [18]	Acute coronary syndrome	Positive UDS within 48 – 72 h of admission	NA	Not specified	During admission or at discharge

Table 2. Definitions, Types of β-Blocker, and Timing of Administration

Study

Symptoms on presentation

Definition of cocaine use

MI definition

Type of BB

Timing of BB administration

BB: β-blocker; ECG: electrocardiogram; ED: emergency department; NA: not available; MI: myocardial infarction; UDS: urine drug screening; IV: intravenous.

Mohamad et al [23]

Chest pain

Positive UDS

MI (or myocardial necrosis): chest pain and troponin I > 0.02 ng/mL

Not specified

On presentation

Dattilo et al [14]

47% chest pain; 2% heart failure; 3% stroke; 3% seizure; 4% overdose

Positive UDS

Troponin I > 0.10 ng/mL or ECG changes ≥ two contiguous leads

66% metoprolol, atenolol, or propranolol; 21% labetalol or carvedilol; 13% both

During admission

Rangel et al [15]

Chest pain

Positive UDS

Troponin > 1.5 ng/mL

74% IV metoprolol; 11% oral metoprolol; 12% IV labetalol; 2% oral labetalol; 1% oral atenolol; 1% oral propranolol

In the ED

Ibrahim et al [17]

Chest pain

Positive UDS and reported cocaine use within the previous 24 h

Troponin I > 0.6 ng/mL and Troponin T > 0.1 ng/mL

53% metoprolol; 27.2% labetalol; 26.6% carvedilol; 2% atenolol

During admission

Fanari et al [16]

Chest pain

Positive UDS and reported cocaine use within the previous 24 h

Troponin T > 0.1 ng/dL or ST-segment elevations in two contiguous leads in ECG

20% metoprolol; 12% labetalol; 11% carvedilol; 1% atenolol

During admission (within the first 24 h)

Schmidt et al [24]

Chest pain

Positive UDS

Positive troponin

50% oral metoprolol; 19% IV metoprolol; 8% IV labetalol; 8% oral carvedilol; 8% oral atenolol; 8% oral propranolol

During admission (while having chest pain) or at discharge

Finks et al [25]

Chest pain

Positive UDS

100% carvedilol

At discharge

Cediel et al [18]

Acute coronary syndrome

Positive UDS within 48 – 72 h of admission

Not specified

During admission or at discharge