Brgdar Ahmed, Gharbin John, Elawad Ayman, Yi Jin, Sanchez Jacob, Bishaw Adey, Taha Mohamed E, Ameyaw Edmund Essah, Allen Norman, Prafulla Mehrotra
Internal Medicine, Howard University Hospital, Washington, DC, USA.
Cardiovascular Medicine, Howard University Hospital, Washington, DC, USA.
Cureus. 2022 Mar 1;14(3):e22737. doi: 10.7759/cureus.22737. eCollection 2022 Mar.
Background Substance use is widely prevalent among young adults and is associated with increased cardiovascular morbidity and mortality such as sudden cardiac arrest, acute coronary syndrome, arrhythmias, and cardiomyopathy. However, they are limited studies analyzing the impact of substance use disorder on in-hospital outcomes among young patients with cardiovascular events. Methods All patients aged 18-39 years admitted primarily for major cardiovascular events including acute myocardial infarction (AMI), arrhythmia, cardiac arrest, acute ischemic stroke, and venous thromboembolic events in 2019 were identified in the National Inpatient Sample database. They were then categorized into those with and without concomitant substance use disorder (SUD). The primary outcome was in-hospital mortality. Unadjusted and adjusted analysis was performed on appropriate variables of interest. Results Of 57,985 hospitalizations with cardiac events, 12,115 (20%) of young adults had concomitant SUD. SUD was significantly associated with cardiac arrest (OR 3.3; CI 2.4-4.4), atrial fibrillation (OR 1.5; CI 1.3-1.7), AMI (OR 1.3; CI 1.2-1.6), heart failure (OR 2.6; CI 2.4-3.0) (all p<0.05) despite a lower prevalence of traditional cardiovascular risk factors than non-users. Logistic regression showed acute kidney injury (aOR 1.5; CI 1.3-1.8; p<0.001) and inpatient mortality (aOR 1.6; CI 1.2-2.2; p<0.001) were also significantly higher in young patients presenting with cardiac events and concomitant SUD. There was no difference in the length of stay or incidence of gastrointestinal bleed between the two groups. Conclusion In young patients presenting with a cardiovascular event, concurrent substance use disorder was associated with increased in-hospital mortality despite significantly lower comorbidities.
物质使用在年轻人中广泛流行，且与心血管疾病发病率和死亡率增加相关，如心脏骤停、急性冠状动脉综合征、心律失常和心肌病。然而，分析物质使用障碍对年轻心血管事件患者住院结局影响的研究有限。方法：在国家住院样本数据库中识别出2019年主要因重大心血管事件入院的所有18 - 39岁患者，包括急性心肌梗死（AMI）、心律失常、心脏骤停、急性缺血性中风和静脉血栓栓塞事件。然后将他们分为伴有和不伴有物质使用障碍（SUD）的两组。主要结局是住院死亡率。对感兴趣的适当变量进行未调整和调整分析。结果：在57,985例有心脏事件的住院患者中，12,115例（20%）年轻人伴有SUD。尽管传统心血管危险因素的患病率低于非使用者，但SUD与心脏骤停（OR 3.3；CI 2.4 - 4.4）、心房颤动（OR 1.5；CI 1.3 - 1.7）、AMI（OR 1.3；CI 1.2 - 1.6）、心力衰竭（OR 2.6；CI 2.4 - 3.0）均显著相关（所有p < 0.05）。逻辑回归显示，伴有心脏事件和SUD的年轻患者急性肾损伤（校正OR 1.5；CI 1.3 - 1.8；p < 0.001）和住院死亡率（校正OR 1.6；CI 1.2 - 2.2；p < 0.001）也显著更高。两组之间住院时间或胃肠道出血发生率无差异。结论：在患有心血管事件的年轻患者中，尽管合并症显著较少，但并发物质使用障碍与住院死亡率增加相关。
