Cocaine Positivity in ST-Elevation Myocardial Infarction: A True or False Association

Ikechukwu Ifedili, Tamunoinemi Bob-Manuel, Siri R. Kadire, Britteny Heard, Leah A. John, Benjamin Zambetti, Mark R. Heckle, Fridtjof Thomas, Showkat Haji, Rami N. Khouzam, Guy L. Reed, Uzoma N. Ibebuogu

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Introduction: Every year, more than 500,000 US Emergency Department visits are associated with cocaine use. People who use cocaine tend to have a lower incidence of true ST-elevation myocardial infarction (STEMI). Objective: To identify the factors associated with true STEMI in patients with cocaine-positive (CPos) findings. Methods: We retrospectively analyzed 1144 consecutive patients with STEMI between 2008 and 2013. True STEMI was defined as having a culprit lesion on coronary angiogram. Multivariate and univariate analyses were used to identify risk factors and create a predictive model. Results: A total of 64 patients with suspected STEMI were CPos (mean age 53.1 ± 11.2 years; male = 80%). True STEMI was diagnosed in 34 patients. Patients with CPos true STEMI were more likely to be uninsured than those with false STEMI (61.8% vs 34.5%, p = 0.03) and have higher peak troponin levels (21.1 ng/mL vs 2.12 ng/mL, p = < 0.01) with no difference in mean age between the 2 groups (p = 0.24). In multivariate analyses, independent predictors of true STEMI in patients with CPos findings included age older than 65 years (odds ratio [OR] = 19.3, 95% confidence iterval [CI] = 1.2-318.3), lack of health insurance (OR = 4.9, 95% CI = 1.2-19.6), and troponin level higher than 0.05 (OR = 24.0, 95% CI = 2.6-216.8) (all p < 0.05). A multivariate risk score created with a C-statistic of 82% (95% CI = 71-93) significantly improved the identification of patients with true STEMI. Conclusion: Among those with suspected STEMI, patients with CPos findings had a higher incidence of false STEMI. Older age, lack of health insurance, and troponin levels outside of defined limits were associated with true STEMI in this group.

Original languageEnglish (US)
Article numberA35
JournalThe Permanente journal
Issue number2
StatePublished - 2019
Externally publishedYes


  • ECG
  • ST-elevation
  • cardiac catheterization
  • cocaine use
  • electrocardiogram
  • false STEMI
  • myocardial infarction

ASJC Scopus subject areas

  • Health(social science)
  • Public Health, Environmental and Occupational Health
  • Health Policy
  • Medicine (miscellaneous)


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