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Three Part Question

In [patients presenting with chest pain following amphetamine use] what [is the incidence] of [acute myocardial infarction]?

Clinical Scenario

You are working in a very busy Accident and Emergency Department and the Triage Nurse informs you that, a patient with "Amphetamine induced chest pain" has just arrived. you wonder , what his chances are, to develop Acute Myocardial Infarction.

Search Strategy

Ovid MEDLINE(R) 1950 to March Week 2 2008
[exp Amphetamine-Related Disorders/or exp Amphetamine/or amphetamine.mp. or methamphetamine.mp. or exp Methamphetamine/or dextroamphetamine.mp. or exp Dextroamphetamine/or exp N-Methyl-3,4-methylenedioxyamphetamine/] AND [chest pain.mp. or exp Chest Pain/or exp Angina, Unstable/or angina.mp. or acute coronary syndrome.mp. or exp Acute Coronary Syndrome/or exp Myocardial Infarction/or myocardial adj injury.mp. or myocardial adj damage.mp.] LIMIT to English language and Human. The Cochrane Library Issue 1 2008. MeSH descriptor Amphetamine explode all trees AND MeSH descriptor Myocardial Infarction explode all trees OR MeSH descriptor Chest Pain explode all trees 0 records.

Search Outcome

A total of 56 articles found. Only one article was relevant.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Turnipseed et al 2003 USA	A 33 patients admitted to University of California,Davis Medical Centre, between January 1994 and January 1996 with the following criteria. (1)Chief complaint of Non traumatic chest pain. (2)urine toxicology screen positive for Methylamphetamine and negative for cocaine. (3)Admission for "rule out MI". (4)chest radiograph demonstrating no infiltrates.	Retrospective survey ( Level 4 Evidence)	Frequency of ACS in patients presenting with Amphetamine induced chest pain was 25%	ACS was diagosed in 9 out of 36 admissions with amphetamine induced chest pain	Retrospective study Single centre study Done at a time when Diagnostic protocols for ACS were based on serial CPK MB measurements, study screened for only Methamphetamine.

Comment(s)

This study is done at a time when both the diagnostic criteria for acute coronary syndrome (ACS), AMI and the range of amphetamines used were different. In this study, ACS diagnosis is based on myocardial type creatine kinase (CK-MB) measurements and also includes unstable angina, which is diagnosed in patients with angina and normal CK-MB relative index and evidence of myocardial ischaemia on non-invasive cardiac stress testing or significant coronary artery disease by coronary angiography. Although this study only screened for methylamphetamine, the range of amphetamines available now has increased many fold.

Clinical Bottom Line

A single study found shows a high incidence of ACS in patients with chest pain post-metamphetamine ingestion. There is, however, no evidence to show the incidence of actual AMI in this situation.

References

1. Samuel D. Turnipseed et al. FREQUENCY OF ACUTE CORONARY SYNDROME IN PATIENTS PRESENTING TO THE EMERGENCY DEPARTMENT WITH CHEST PAIN AFTER METHAMPHETAMINE USE. The Journal of Emergency Medicine vol.24(4), pp. 369-373, 2003.