No registrations found.
ID
Source
Brief title
Health condition
Chest pain, cocaine
Pijn op de borst, cocaine
Sponsors and support
Intervention
Outcome measures
Primary outcome
Incidence of ACS
Secondary outcome
Observation time in the department; re-admittance to hospital after discharge; recurrent chest pain with presentation to medical specialist; recurrent chest pain without presentation to medical specialist; no recurrent chest pain symptoms, discontinuation or continued cocaine abuse.
Background summary
Rationale: To determine whether the international European Society of Cardiology (ESC) guideline for ACS can be applied for ruling out ACS in patients with cocaine associated chest pain (CACP), at the emergency department (ED)/coronary care unit (CCU) in the Netherlands. No protocol is supported yet by the Dutch Heart Association or the Dutch Society for Emergency Medicine for ruling out ACS in patients with chest pain after recent cocaine use. sThe most applicable article refers to studies which demonstrated that low- to intermediate- risk patients with CACP can be safely discharged after 12 hours of observation. This literature is limited and outdated and does not involve use of modern, high sensitive cardiac enzymes.
A survey conducted among Dutch emergency physicians and cardiologists shows that knowledge about cocaine as a risk factor is moderate and observation time for patients with CACP is variable. Generally, the ESC ACS guideline is the standard of care applied by most physicians: discharge of low- and intermediate risk patients if: - an EKG not suspect for STelevated myocardial infarct (STEMI), and –representative negative cardiac enzymes. The hypothesis of this research therefore is that the international ESC ACS guideline is valid for ruling out ACS in patients with CACP. If proven right, this will lead to an evidence based protocol for shorter observation periods of patients with CACP on ED/CCU wards.
Objective:
Main objective:
To determine if the ESC ACS guidelines (the 0h/3h rapid rule out protocol, as well as the 0h/1h rapid rule out protocol) can be applied for ruling out ACS on the ED/CCU for patients with cocaine associated chest pain.
Study design: Multi centre, observational, prospective cohort study
Study population: Patients with symptoms of chest pain and a history positive for cocaine use in past four days, or age 18-45 years and urine toxicology screening positive for cocaine.
Intervention: Patients will be treated according to the local guidelines. Urine toxicology screening will be done. Since two protocols are both evaluated at the same time, one additional blood sample will be necessary in the 0h/3h and the 0h/1h protocol centres.
Low- to intermediate risk patients will be discharged after displaying representative negative cardiac enzymes according to both rapid rule out protocols. The cocaine positive patients will be contacted 4-8 weeks after discharge for follow up.
Study objective
ESC ACS guideline can be applied for ruling out ACS on the ED/CCU for patients with cocaine associated chest pain
Study design
none
Intervention
None. Observation of standard of care treatment.
Inclusion criteria
Patients with symptoms of chest pain and a history for cocaine use in the past four days. If age >18 and <46 years old, urine screening positive for cocaine use, in possession of and access to email or telephone number, and with informed consent to contact them and/or their GP for follow up.
Exclusion criteria
age <18 and >45 without a history cocaine use in the past four days and a negative toxicology screen. No chest pain or chest pain caused by trauma or other clearly diagnosed non cardiac causes of chest pain.
Design
Recruitment
IPD sharing statement
Followed up by the following (possibly more current) registration
Other (possibly less up-to-date) registrations in this register
No registrations found.
In other registers
| Register | ID |
|---|---|
| NTR-new | NL5243 |
| NTR-old | NTR5500 |
| CCMO | NL57552.100.16 |
| OMON | NL-OMON47778 |