Opioid use disorder and clinical outcomes following percutaneous coronary intervention for acute coronary syndromes

Opioid use disorder (OUD) is increasingly encountered among patients presenting with acute coronary syndromes (ACS), yet its impact on outcomes following percutaneous coronary intervention (PCI) remains unclear. We conducted a single-center retrospective cohort study of 5,875 patients undergoing PCI for ACS between 2012 and 2019. Patients were stratified by documented OUD identified using ICD-9 and ICD-10 codes. In-hospital, 30-day, 6-month, and 1-year Outcomes were assessed using multivariable logistic regression, propensity score matching, and time-to-event analyses. Compared with non-OUD patients, those with OUD were more likely to be African American, active smokers, and to have chronic obstructive pulmonary disease, but had lower rates of diabetes. After adjustment, OUD was associated with significantly higher odds of LifeVest prescription during the index hospitalization (adjusted OR 9.94, 95% CI 3.13-31.55). At 30 days, OUD was independently associated with higher risks of any-lesion coronary reintervention (adjusted OR 2.90, 95% CI 1.49-5.66) and same-lesion reintervention (adjusted OR 4.76, 95% CI 1.93-11.77). At 1 year, OUD showed a trend toward higher congestive heart failure readmission (adjusted OR 3.05, 95% CI 0.91-10.28), without significant associations with recurrent ACS or all-cause mortality. Among patients undergoing PCI for ACS, OUD is associated with increased early coronary reintervention and greater likelihood of LifeVest prescription, without increased mortality. These findings highlight a vulnerable population that may benefit from enhanced post-PCI monitoring and multidisciplinary care.