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Preadmission Opioid Use and 1-Year Mortality Following Incident Myocardial Infarction: A Danish Population-Based
Søren Korsgaard1,2, Troels Munch1,2, Erzsébet Horváth-Puhó1,2
1Department of Clinical Epidemiology Aarhus University Hospital Aarhus Denmark.
Insights
Opioid use before a heart attack significantly increases the risk of death within one year. Current opioid users face the highest mortality risk following myocardial infarction compared to non-users.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
- Epidemiology
Background:
- Opioid use is a known risk factor for myocardial infarction and cardiovascular mortality.
- The prognostic impact of pre-existing opioid use on outcomes after myocardial infarction remains largely uncharacterized.
Purpose of the Study:
- To investigate the association between pre-admission opioid use and 1-year all-cause mortality in patients experiencing a first myocardial infarction.
- To identify specific opioid use patterns (current, recent, former) associated with increased mortality risk post-myocardial infarction.
Main Methods:
- Nationwide population-based cohort study in Denmark (1997-2016) including 162,861 patients hospitalized for incident myocardial infarction.
- Patients categorized into current (0-30 days), recent (31-365 days), former (>365 days), and non-opioid users based on prescription data.
- One-year all-cause mortality analyzed using Kaplan-Meier method and Cox regression, adjusting for demographics, comorbidities, and pre-infarction medication use.
Main Results:
- Current opioid users comprised 8% of the cohort, with a 1-year mortality rate of 42.5%.
- Compared to non-users (20.5% mortality), current opioid users exhibited a significantly elevated adjusted 1-year all-cause mortality risk (HR 1.26).
- Neither recent nor former opioid users demonstrated an increased risk of 1-year mortality after adjusting for confounders.
Conclusions:
- Preadmission opioid use, particularly current use, is independently associated with increased 1-year all-cause mortality following myocardial infarction.
- Patients with myocardial infarction who are current opioid users represent a high-risk subgroup requiring targeted management strategies.
- Findings highlight the importance of considering pre-existing opioid use in risk stratification and treatment planning for myocardial infarction patients.
Abstract:
Background Opioid use has been linked to an increased risk of myocardial infarction and cardiovascular mortality, but the prognostic impact of opioid use before an incident myocardial infarction is largely unknown. Methods and Results We conducted a nationwide population-based cohort study including all patients hospitalized for an incident myocardial infarction in Denmark (1997-2016). Based on their last redeemed opioid prescription before admission, patients were categorized as current users (0-30 days), recent users (31-365 days), former users (>365 days), and nonusers. One-year all-cause mortality was calculated using the Kaplan-Meier method. Hazard ratios (HRs) were computed using Cox proportional hazards regression analyses, adjusting for age, sex, comorbidity, any preceding surgery within 6 months before the myocardial infarction admission, and medication use before the myocardial infarction admission. We identified 162 861 patients with an incident myocardial infarction. Of these, 8% were current opioid users, 10% were recent opioid users, 24% were former opioid users, and 58% were nonusers of opioids. One-year mortality was highest among current users (42.5% [95% CI, 41.7%-43.3%]) and lowest among nonusers (20.5% [95% CI, 20.2%-20.7%]). Compared with nonusers, current users had an elevated 1-year all-cause mortality risk (adjusted HR, 1.26 [95% CI, 1.22-1.30]). Following adjustment, neither recent users nor former users of opioids were at elevated risk. Conclusions Preadmission opioid use was associated with an increased 1-year all-cause mortality risk following an incident myocardial infarction. Opioid users thus represent a high-risk subgroup of patients with myocardial infarction.
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