• Kevin Bryan Lo, Hafeez Ul Hassan Virk, Vladimir Lakhter, Pradhum Ram, Carlos Gongora, Gregg Pressman, and Vincent Figueredo.
• Department of Medicine. Electronic address: lokevinb@einstein.edu.
• Am. J. Med. 2019 Apr 1; 132 (4): 505-509.

BackgroundRecent guidelines have suggested avoiding beta-blockers in the setting of cocaine-associated acute coronary syndrome. However, the available evidence is both scarce and conflicted. The purpose of this systematic review and meta-analysis is to investigate the evidence pertaining to the use of beta-blockers in the setting of acute cocaine-related chest pain and its implication on clinical outcomes.MethodsElectronic databases were systematically searched to identify literature relevant to patients with cocaine-associated chest pain who were treated with or without beta-blockers. We examined the end-points of in-hospital all-cause mortality and myocardial infarction. Pooled risk ratios (RR) and their 95% confidence intervals (CI) were calculated for all outcomes using a random-effects model.ResultsFive studies with a total of 1447 patients were included. Our analyses found no differences between patients treated with or without beta-blockers for either myocardial infarction (RR 1.08; 95% CI, 0.61-1.91) or all-cause mortality (RR 0.75; 95% CI, 0.46-1.24). Heterogeneity among included studies was low to moderate.ConclusionThis systematic review and meta-analysis suggests that beta-blocker use is not associated with adverse clinical outcomes in patients presenting with acute chest pain related to cocaine use.Copyright © 2018 Elsevier Inc. All rights reserved.

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