Ase 2000 V2 Crack Cocaine ((EXCLUSIVE))

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Ase 2000 V2 Crack Cocaine

Although thrombolytics are indicated in all patients with cocaine-associated MI, their use should be cautiously considered because of potential interactions with cocaine and cocaine metabolites. ²⁴ In fact, several case reports described cases of spontaneous coronary artery dissection in patients in the hours to days after thrombolytic therapy. ^{126,127,128,129} The increased myocardial metabolic demands of ischemic myocardium after thrombolytic therapy are also a potential concern. ¹³⁰

Lipid-lowering therapy is not indicated in patients with cocaine-related chest pain and MI because of the scarcity of data that such therapy will result in a decrease in recurrent ischemic events in this population. ¹⁰

In patients with cocaine-associated chest pain and unstable angina, the outcomes of early referral for cardiac catheterization are not different from those of patients with ACS without cocaine use. ^36,38 Patients with unstable angina and low or intermediate levels of cardiac troponin I were transferred to an observation unit for further evaluation in the cardiology intensive care unit and initiation of medical therapy. After 4 hours of medical therapy, the myocardial injury markers decreased, and patients then were discharged home. Patients with unstable angina with high levels of cardiac troponin I were directly admitted to the cardiology intensive care unit for cardiac catheterization.

In a prospective randomized study, 256 patients with suspected cocaine-associated chest pain (n = 45) were evaluated. ³² All were admitted for evaluation and treatment, with 72% admitted to an observation unit. About half of the patients had ACS and half did not. After a median follow-up of 17 months, mortality was higher among patients with cocaine-associated ACS than among patients with noncocaine-associated ACS (19 versus 5 deaths per 100 person-years; P.001).

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