阿片类药物成瘾是否会影响接受急诊经皮冠状动脉介入治疗（PCI）的ST段抬高型心肌梗死（STEMI）患者的临床和血管造影结果？

Does Opioid Addiction Influence Clinical and Angiographic Outcomes in STEMI Patients Undergoing Emergency PCI?

作者信息

Amirpour Afshin, Kermani-Alghoraishi Mohammad, Sattar Fereshteh, Roohafza Hamidreza, Shahabi Javad, Zavar Reihaneh, Sadeghi Masoumeh

机构信息

Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.

Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.

出版信息

Adv Biomed Res. 2023 Jan 27;12:12. doi: 10.4103/abr.abr_295_21. eCollection 2023.

DOI:10.4103/abr.abr_295_21

PMID:36926439

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10012017/

Abstract

BACKGROUND

Despite recognizing the traditional coronary artery disease (CAD) risk factors, some secondary factors, such as opioid substance abuse, have to be considered. We aimed to assess the relationship between opioid consumption and emergency percutaneous coronary intervention (PCI) revascularization results, according to Thrombolysis in Myocardial Infarction (TIMI) flow and in-hospital survival outcomes in ST-elevation myocardial infarction (STEMI) patients.

MATERIALS AND METHODS

This case-control study was conducted on 186 patients (93 patients in each group) with acute STEMI, who were referred to Chamran Heart Center, Isfahan, Iran. Opioid addiction was diagnosed by patients' records and confirmed by conducting an interview based on the Diagnostic and Statistical Manual of Mental Disorders, 4 Edition (DSM-IV) criteria. Patients in both groups were evaluated and compared for angioplasty results based on the TIMI flow grade and in-hospital cardiovascular events and complications.

RESULTS

Ninety-one patients (97.84%) of each group were male, and opioid-addicted patients were younger than the non-opioid users (52.95 9.91 vs. 57.90 12.17, = 0.003). Among the CAD risk factors, prevalence of dyslipidemia was significantly higher in non-opioid users, whereas cigarette smoking was higher in opioid-addicted patients ( < 0.050). There was no significant difference between the two groups regarding pre- and post-procedural myocardial infarction complications as well as mortality rate ( > 0.050). Also, there were no significant differences between the opioid and non-opioid users regarding TIMI flow grading, and successful PCI rate based on achieving TIMI III was 60.21% versus 59.1% in opiate-dependent and non-opioid users, respectively ( = 0.621).

CONCLUSION

Opioid addiction has no effects on post-PCI angiographic results and in-hospital survival outcomes in STEMI patients which undergoing emergency PCI.

摘要

背景

尽管认识到传统的冠状动脉疾病（CAD）危险因素，但一些次要因素，如阿片类物质滥用，也必须予以考虑。我们旨在根据心肌梗死溶栓（TIMI）血流情况以及ST段抬高型心肌梗死（STEMI）患者的院内生存结局，评估阿片类药物使用与急诊经皮冠状动脉介入治疗（PCI）血管重建结果之间的关系。

材料与方法

本病例对照研究针对186例急性STEMI患者（每组93例）进行，这些患者被转诊至伊朗伊斯法罕的查姆兰心脏中心。通过患者记录诊断阿片类药物成瘾，并根据《精神疾病诊断与统计手册》第4版（DSM-IV）标准进行访谈予以确认。对两组患者基于TIMI血流分级的血管成形术结果以及院内心血管事件和并发症进行评估和比较。

结果

每组91例患者（97.84%）为男性，阿片类药物成瘾患者比非阿片类药物使用者更年轻（52.95±9.91岁 vs. 57.90±12.17岁，P = 0.003）。在CAD危险因素中，非阿片类药物使用者血脂异常的患病率显著更高，而阿片类药物成瘾患者吸烟率更高（P<0.050）。两组在术前和术后心肌梗死并发症以及死亡率方面无显著差异（P>0.050）。此外，阿片类药物使用者和非阿片类药物使用者在TIMI血流分级方面也无显著差异，基于达到TIMI III的成功PCI率在阿片类药物依赖者和非阿片类药物使用者中分别为60.21%和59.1%（P = 0.621）。