Comparative analysis of in-hospital outcomes in opioid-dependent vs. non-opioid-dependent STEMI patients

Objectives: Myocardial infarction is a leading cause of death worldwide. The effect of opioid dependence on myocardial infarction outcomes remains uncertain, with conflicting results in the literature. This study aimed to assess the in-hospital and six-month outcomes of opioid-dependent compared to non-dependent patients with ST-elevation myocardial infarction (STEMI) at Afshar Heart Center, Yazd. Methods: This cross-sectional analytical study included 200 STEMI patients admitted to Afshar Heart Center in Yazd, Iran, between 2020 and 2021. Patients were divided into opioid-dependent and non-opioid-dependent groups based on the DSM-IV criteria for opioid use. The inclusion criteria were chest pain lasting at least 30 minutes, specific ST-segment elevation on ECG, and elevated serum creatine kinase levels. Patients with a history of myocardial infarction or other cardiac or pulmonary diseases were excluded. Demographic and clinical data were collected from hospital records and analyzed using SPSS v.22. Results: Multivariate analysis showed that opioid dependence was significantly linked to in-hospital outcomes. Although in-hospital mortality was higher for opioid-dependent patients compared to non-dependent patients (8.3% vs. 1.7%, p = 0.34), this difference was not statistically significant. Interestingly, six-month mortality occurred only in the non-dependent group (3.4% vs. 0%, p = 0.095). The duration from symptom onset to hospital arrival was considerably shorter in opioid users (154.01 ± 190.38 minutes) than in non-users (271.62 ± 287.58 minutes, p < 0.01), which may have contributed to earlier reperfusion. Despite these differences, there were no significant differences between the groups regarding revascularization strategies or left ventricular ejection fraction (EF: 38.15% vs. 38.52%, p = 0.974). Conclusions: Opioid dependency greatly affects the prognosis of STEMI patients, highlighting the importance of targeted interventions and additional research