How Does Opium Dependency Affect the Myocardial Infarction Outcomes? :

BACKGROUND

Acute Coronary Syndrome (ACS) remains a leading global cause of mortality, with multiple established risk factors. While smoking is widely recognized, opium use poses a significant health concern, particularly in developing nations. Despite traditional beliefs suggesting potential cardioprotective effects, growing evidence indicates a detrimental impact of opium consumption on cardiovascular health. This study aimed to investigate the association between opium dependence and the clinical outcomes of patients experiencing ACS.

MATERIALS AND METHOD: This study, conducted on 165 patients with ST-elevation myocardial infarction (STEMI) and Non-ST-elevation myocardial infarction (NSTEMI) referred to the Qom Heart Center, Qom, Iran from 2022 to 2024. The patients were categorized in two groups: 81 opium-dependent patients based on DSM-V criteria as a case group and 84 non-opium-dependent patients as a control group, and their clinical outcomes were compared.

RESULTS

Coronary artery involvement was significantly more severe in opium-dependent patients ie three vessel disease (3VD) or left main stenosis (LM) involvement in the opium-dependent group was 48.1% versus 28.6% in the non-opium-dependent group, (P-value=0.01). Prevalence of atrial fibrillation (AF) and delay in hospital admission and the hospitalization days were higher in the opium-dependent group. LVEF at the admission did not differ between the two groups, but left ventricle ejection fraction (LVEF) three months later was higher in the opium-dependent group. Rehospitalization, arrhythmia, mechanical complications, need for CABG, and mortality during the initial hospitalization did not differ between the two groups. The mortality of the patients in the six-month follow-up was 6.5% in the opium-dependent group and 8.6% in the non-opium-dependent group (P-value=0.61) which did not show a significant difference. This issue shows the lack of significant role of opium consumption in the mortality of patients.

CONCLUSION

Our findings suggest a strong association between opium dependence and a more severe clinical presentation of ACS, characterized by a higher burden of coronary artery disease. Although initial LVEF recovery appeared faster in opium-dependent individuals, the overall impact on long-term mortality remained inconclusive within the six-month follow-up period. These findings underscore the critical need for further research to elucidate the complex interplay between opium dependence and cardiovascular outcomes in ACS patients, including long-term follow-up and exploration of potential underlying mechanisms.