Abstract
Objective:
To critically evaluate the 30 year debate of β-blocker use in cocaine-induced acute coronary syndrome (CIACS).
Data Sources:
An Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, and Ovid MEDLINE (1966–August 21, 2007) search of the medical literature was conducted using the key terms cocaine, myocardial infarction, acute coronary syndrome, and adrenergic β-antagonists.
Study Selection and Data Extraction:
All clinical trials, case reports, national cardiovascular guidelines, and reviews published in English were evaluated. Case reports were included based on whether (1) acute coronary syndrome was suspected, (2) a β-blocker was used during the treatment course, and (3) objective and subjective patient-specific information was documented.
Data Synthesis:
Three case reports and 2 placebo-controlled trials were identified that used 4 β-blockers (atenolol, labetalol, metoprolol, propranolol). Three national guidelines addressed β-blocker use. Although published data are limited, propranolol and labetalol exert minimal to no effect on alleviating cocaine-induced coronary vasoconstriction. None of the evaluated national guidelines recommends β-blockers as first-line agents in CIACS management.
Conclusion:
β-Blockers should not be considered first-line agents for controlling chest pain in patients with documented CIACS. If long-term β-blockade is warranted, its benefits should be weighed against recurrent use of cocaine and possible exacerbation of acute coronary syndrome. Given that carvedilol exhibits ancillary pharmacologic proprieties beneficial in CIACS, and post-myocardial infarction mortality data are available regarding its use, this agent could be considered to be appropriate therapy.
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