{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:42:58Z","timestamp":1787013778444,"version":"build-2736575974"},"reference-count":29,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2022,9,8]],"date-time":"2022-09-08T00:00:00Z","timestamp":1662595200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["1T32 HL129974\u201001"],"award-info":[{"award-number":["1T32 HL129974\u201001"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000026","name":"National Institute on Drug Abuse","doi-asserted-by":"publisher","award":["DA037317"],"award-info":[{"award-number":["DA037317"]}],"id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000026","name":"National Institute on Drug Abuse","doi-asserted-by":"publisher","award":["R01DA048009"],"award-info":[{"award-number":["R01DA048009"]}],"id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2023,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Cocaine use results in over 500,000 emergency department (ED) visits annually across the United States and ethanol co\u2010ingestion is reported in 34% of these. Commingling cocaine with ethanol results in the metabolite cocaethylene (CE), which is metabolically active for longer than cocaine alone. Current literature on the cardiotoxicity of CE compared to cocaine alone is limited and lacks consensus. This study aims to fill this gap in the literature and examine cardiovascular events in cocaine use as confirmed by urine toxicology versus CE exposure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a secondary data analysis of a prospective cohort study of adult patients with acute drug overdose at two urban tertiary care hospital EDs over 4\u2009years. Patients with positive urinary cocaine metabolites were analyzed, and outcomes were compared between patients with overdose and confirmed presence of cocaine on urine toxicology (cocaine group) and patients with cocaine and ethanol use (CE group). The primary outcome was cardiac arrest. Secondary outcomes included myocardial injury and hyperlactatemia. Data were analyzed using multivariable regression models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We enrolled a total of 199 patients (150 cocaine, 49\u2009CE). Rates of cardiac arrest were significantly higher in the CE group compared to cocaine (6.1% vs. 0.67%,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u20090.048). Cocaine was significantly associated with myocardial injury compared to CE exposure (mean initial troponin 0.01\u2009ng\/ml vs. 0.16\u2009ng\/ml,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u20090.021), while hyperlactatemia was associated with CE exposure (mean initial lactate 4.1\u2009mmol\/L vs. 2.9\u2009mmol\/L,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u20090.038).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>When compared to cocaine exposure alone, CE exposure in ED patients with acute drug overdose was significantly associated with higher occurrence of cardiac arrest, higher mean lactate concentrations, and lower occurrence of myocardial injury.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/acem.14584","type":"journal-article","created":{"date-parts":[[2022,8,24]],"date-time":"2022-08-24T03:53:02Z","timestamp":1661313182000},"page":"82-88","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Cocaethylene cardiotoxicity in emergency department patients with acute drug overdose"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4618-5800","authenticated-orcid":false,"given":"Siri","family":"Shastry","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine Icahn School of Medicine at Mount Sinai  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omid","family":"Manoochehri","sequence":"additional","affiliation":[{"name":"Emergency Medicine Residency Icahn School of Medicine at Mount Sinai  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lynne D.","family":"Richardson","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Icahn School of Medicine at Mount Sinai  New York New York USA"},{"name":"Institute for Health Equity Research Icahn School of Medicine at Mount Sinai  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8276-9320","authenticated-orcid":false,"given":"Alex F.","family":"Manini","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Icahn School of Medicine at Mount Sinai  New York New York USA"},{"name":"Division of Medical Toxicology, Department of Emergency Medicine Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,9,8]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"Substance Abuse and Mental Health Services Administration Drug Abuse Warning Network 2011: National estimates of drug\u2010related emergency department visits. 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