Dogma Challenged — β-Blockers for Patients with Cocaine-Associated Chest Pain?

Despite the proven survival benefit of β-blockers in patients with myocardial infarction, traditional teaching and current guidelines dictate that they are contraindicated in patients with cocaine-associated chest pain (Circulation 2008; 117:1897). β-blockers might exacerbate the toxic cardiovascular effects of cocaine, such as coronary vasospasm and hypertension, secondary to “unopposed” α stimulation. However, evidence supporting this hypothesis is not robust.

Researchers performed a retrospective study to assess the safety of β-blockers in 311 consecutive patients in San Francisco who were admitted for chest pain and tested positive for cocaine by urine drug screens. (Those with pulmonary etiologies of chest pain were excluded.) Patients …