Is Cocaine-associated Acute Myocardial Infarction the Same as Myocardial Infarction Associated With Recent Cocaine Consumption? Response

We agree with Carrillo et al with regard to the importance of the information bias when dealing with cocaine use. Nevertheless, other factors also explain the differences between our results and the findings reported in their study, carried out in a coronary critical care unit (CCCU). In a study by Gupta et al involving 102 952 acute myocardial infarction patients in 364 hospitals participating in the American College of Cardiology Registry of the United States, only 924 patients (0.9%) of all ages were cocaine-positive, defined as use of the drug within the preceding 72 hours or its presence in urine. Extrapolation of the results of a study involving 87 hospitals (Spain) or 364 hospitals (United States)—in patients with confirmed acute myocardial infarction from different geographical areas, treated in different types of hospitals and departments, and of different ages—to the findings in a single CCCU in which acute coronary syndrome was studied in patients under 50 years of age is