How Does Opium Dependency Affect the Myocardial Infarction Outcomes? :

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.

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.

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.

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.