{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T20:39:25Z","timestamp":1785530365022,"version":"3.56.0"},"reference-count":25,"publisher":"BMJ","issue":"9","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Emerg Med J"],"accepted":{"date-parts":[[2018,5,30]]},"published-print":{"date-parts":[[2018,9]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>Beta blockers (\u03b2-blockers) remain a standard therapy in the early treatment of acute coronary syndromes. However, \u03b2-blocker therapy in patients with cocaine-associated chest pain (CACP) continues to be an area of debate due to the potential risk of unopposed \u03b1-adrenergic stimulation and coronary vasospasm. Therefore, we performed a systematic review and meta-analysis of available studies to compare outcomes of \u03b2-blocker versus no \u03b2-blocker use among patients with CACP.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We searched the MEDLINE and EMBASE databases through September 2016 using the keywords \u2018beta blocker\u2019, \u2018cocaine\u2019 and commonly used \u03b2-blockers (\u2018atenolol\u2019, \u2018bisoprolol\u2019, \u2018carvedilol\u2019, \u2018esmolol\u2019, \u2018metoprolol\u2019 and \u2018propranolol\u2019) to identify studies evaluating \u03b2-blocker use among patients with CACP. We specifically focused on studies comparing outcomes between \u03b2-blocker versus no \u03b2-blocker usage in patients with CACP. Studies without a comparison between \u03b2-blocker and no \u03b2-blocker use were excluded. Outcomes of interest included non-fatal myocardial infarction (MI) and all-cause mortality. Quantitative data synthesis was performed using a random-effects model and heterogeneity was assessed using Q and I<jats:sup>2<\/jats:sup>statistics.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of five studies evaluating 1794 subjects were included. Overall, there was no significant difference on MI in patients with CACP on \u03b2-blocker versus no \u03b2-blocker (OR 1.36, 95%\u2009CI 0.68 to 2.75; p=0.39). Similarly, there was no significant difference in all-cause mortality in patients on \u03b2-blocker versus no \u03b2-blocker (OR 0.68, 95%\u2009CI 0.26 to 1.79; p=0.43).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In patients presenting with acute chest pain and underlying cocaine, \u03b2-blocker use does not appear to be associated with an increased risk of MI or all-cause mortality.<\/jats:p><\/jats:sec>","DOI":"10.1136\/emermed-2017-207065","type":"journal-article","created":{"date-parts":[[2018,6,19]],"date-time":"2018-06-19T16:25:43Z","timestamp":1529425543000},"page":"559-563","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":22,"title":["Outcomes of beta blocker use in cocaine-associated chest pain: a meta-analysis"],"prefix":"10.1136","volume":"35","author":[{"given":"Don","family":"Pham","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Addison","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Waleed","family":"Kayani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arunima","family":"Misra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hani","family":"Jneid","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jon","family":"Resar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nassir","family":"Lakkis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahboob","family":"Alam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2018,6,19]]},"reference":[{"key":"2024052702060186000_35.9.559.1","unstructured":"European Monitoring Centre for Drugs and Drug Addiction. 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