12-hour protocol safe for cocaine-associated chest pain

A 12-hour emergency department observation period is safe for patients with cocaine-associated chest pain, provided they have symptoms consistent with low-to-intermediate likelihood of unstable angina according to the Braunwald classification, and normal serial troponin I levels and cardiogram.

Patients with traditional cardiac risk factors should undergo cardiac stress testing within 2 weeks following the chest pain event, as atherosclerosis enhances the vasoconstrictive effects of cocaine. All patients should be referred for substance abuse counseling, as recurrent cocaine use was associated with subsequent nonfatal myocardial infarction (MI).