Comparison of Hospitalization Trends and Outcomes in Acute Myocardial Infarction Patients with versus without Opioid Use Disorder.

Abstract

Discrepancies in medical care are well known to adversely affect patients with opioid abuse disorders (OUD), including management and outcomes of acute myocardial infarction (AMI) in patients with OUD. We used the National Inpatient Sample was queried from Jan 2006 to Sept 2015 to identify all patients ≥18years admitted with a primary diagnosis of AMI (weighted N=13,030; unweighted N=2670) and concomitant OUD. Patients using other non-opiate illicit drugs were excluded. Propensity matching (1:1) yielded well matched 2253 pairs among which intergroup comparison of invasive revascularization strategies and cardiac outcomes was performed. The prevalence of OUD patients with AMI over the last decade has doubled, from 163 (2006) to 326 cases (2015) per 100 000 admissions for AMI. The OUD group underwent less cardiac catheterization (63.2% vs 72.2%; p<0.001), percutaneous coronary intervention (37.0% vs 48.5%; p<0.001) and drug eluting stent placement (32.3% vs 19.5%; p<0.001) compared to non-OUD. No differences in in-hospital mortality/cardiac outcomes were noted. Among subgroup of STEMI patients (26.2% of overall cohort), the OUD patients were less likely to receive percutaneous coronary intervention (67.9% vs 75.5%; p=0.002), drug eluting stent (31.4% vs 47.9%; p<0.001) with a significantly higher mortality (7.4% vs 4.3%), and cardiogenic shock (11.7% vs 7.9%). No differences in the frequency of coronary bypass grafting was noted in AMI or its subgroups. In conclusion, OUD patients presenting with AMI receive less invasive treatment compared to those without OUD. OUD patients presenting with STEMI have worse in-hospital outcomes with increased mortality and cardiogenic shock.