We read with interest the recent article examining the role of BBs in patients with presumed cocaine-associated chest pain.1 Although the authors concluded that BBs did not appear to be associated with adverse events such as death, dysrhythmias, or abnormal electrocardiographic findings, and were even perhaps beneficial, we believe that this is an overstatement and a potentially dangerous recommendation considering the limitations of this study. Being a retrospective study, there is no standardization of care between the 2 groups studied. The administration of BBs was left to the discretion of the treating physician, leading to a potential systemic bias. Furthermore, the group that received BBs also received significantly greater cardioprotective medications including nitroglycerin, aspirin, and statins, which may have skewed the data.
Gupta AK, Greller HA, Hoffman RS. β-Blockers and Cocaine: Still a Bad Idea. Arch Intern Med. 2010;170(20):1859–1860. doi:10.1001/archinternmed.2010.398