Effect of Opioid Use Disorder on Outcomes of Patients With ST-Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention: A Report from the National Inpatient Sample

Background:
Patients with opioid use disorder (OUD) are known to have worse hospital outcomes after surgical procedures. We sought to determine the prevalence of OUD and their effect on outcomes in patients undergoing percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI).

Methods:
We queried the National Inpatient Sample from Jan 2006 to Sept 2015 to identify all patients ≥18 years admitted with primary diagnosis of STEMI undergoing PCI during the admission with appropriate ICD-9 codes. Patients were divided into two groups: 1. Patients with OUD 2. Patients with no OUD. Patients undergoing coronary bypass grafting or with concomitant other illicit drug abuse were excluded. Primary outcome was all-cause in-hospital mortality with secondary outcomes as mentioned in Table 1.

Results:
Out of 1199123 patients undergoing PCI for STEMI, 2212 (0.18%) of patients had OUD. Mean age was 61.5 years with 29.1% females. Significant increase in the OUD patients from 134 cases/100000 patients in 2006 to 279 cases/100000 patients in 2015 (p< 0.001) was noted. No inter-group difference in mortality was seen. OUD patients experienced significantly higher rates of cardiogenic shock, cardiac arrest/ventricular fibrillation and need for blood transfusion compared their counterparts. No difference in vascular complications, acute kidney injury requiring hemodialysis and acute ischemic stroke were observed.

Conclusions:
Our study demonstrated a higher risk of major hospital complications in patients with OUD undergoing PCI for STEMI. Further research is needed to understand the underlying reasons for the observed differences.