Stent Type and Outcomes in Substance Abuse Patients Undergoing Percutaneous Coronary Intervention Following ST Elevation Myocardial Infarction

Background
Use of drug eluting stents (DES) in patients undergoing percutaneous coronary intervention results in lower revascularization compared to bare metal stents (BMS). DES however requires longer duration of dual antiplatelets which may affect the type of stents used in substance abuse (SA) patients following ST elevation myocardial infarction (STEMI). We studied the stent types and their associated outcomes in STEMI in patients with SA disorder.

Methods
A retrospective analysis of National Inpatient Sample was performed to identify study population. A one to one propensity score matching for the age, gender and hospital region was done. Univariate (Chi Square, t test) and multivariate logistic regression models were employed. Generalized linear model was used to estimate hospital length of stay (LOS) and cost.

Results
Out of 16,022 SA patients who had PCI following STEMI, 42.8% had BMS and 57.2% had DES. In non-SA counterparts, 27.2% had BMS and 72.8% had DES. DES group was older 54 vs. 53 and had higher number of Whites 70% vs. 62% as compared to BMS (all P<0.001). Mortality was higher in BMS 2.9% vs. 1.5% DES, P <0.001. In adjusted analysis, BMS had higher odds of mortality (OR 2.18, 95% CI: 1.71-2.79), lower cost (Beta -3,355) and shorter LOS (Beta: 0.5) (all P<0.05) as compared to DES. (Figure 1)

Conclusions
This study shows that SA patients receive less DES and more BMS as compared to non-SA patients following STEMI. BMS is associated with higher mortality and lower cost after STEMI. Further research is warranted to evaluate this disparity in SA patients.