Cocaine and Chest Pain

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To the Editors: The article by Gitter and colleagues (1) presents findings similar to those from our own study (2). The authors, however, have placed undue importance on the 0% myocardial infarction rate in their cohort of patients hospitalized for chest pain after cocaine use. Their retrospective analysis has many inherent problems (as they acknowledge)—for example, incomplete electrocardiographic (ECG) data (41%) and the lack of serial creatine kinase-MB fraction measurements (9%). Because criteria for the diagnosis of acute myocardial infarction include a typical history, serial ECG changes, and an elevated creatine kinase-MB fraction, some of their patients may indeed have

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