Abdan Leili, Nematollahi Soroush, Masoudkabir Farzad, Jalali Arash, Pashang Mina, Vasheghani-Farahani Ali, Hosseini Kaveh, Pourhosseini Hamidreza
Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of).
Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
BMJ Open. 2024 Dec 11;14(12):e090471. doi: 10.1136/bmjopen-2024-090471.
Recent studies have suggested a potential link between opium consumption and microvascular dysfunction in coronary arteries, which may contribute to the development of coronary slow-flow syndrome. This study aims to investigate the relationship between opium use and coronary slow-flow syndrome.
This retrospective study analysed medical records of patients who underwent coronary angiography at the Tehran Heart Center from 2006 to 2020. It focused on those with coronary slow flow phenomenon (CSFP) or non-obstructive coronary artery disease, excluding patients with significant left ventricular dysfunction (left ventricular ejection fraction <40%), previous coronary revasculariation, arrhythmias or coronary artery ectasia. The coronary slow flow was assessed using thrombolysis in myocardial infarction flow grade and frame count. Propensity score matching and inverse probability weighting were applied to minimise confounding variables. Conditional logistic regression and logistic regression models were then used to examine the association between opium use and coronary slow flow, controlling for potential confounders.
Among 21 835 patients with normal coronary angiograms, 767 were identified with CSFP and matched with 3068 controls. The mean age of CSFP patients was 51.59 years, with 64.6% male. Opium use was similar, reported in 8.9% of CSFP patients and 9.5% of controls (p=0.96). Within the CSFP group, opium use was associated with more extensive coronary artery involvement (33.3% vs 18.9%, p=0.03). Initial analysis indicated a higher risk for CSFP in opium users (OR: 1.74, p=0.001), but after adjustments, no significant association was found (OR: 1.06, p=0.70; OR: 1.15, p=0.55).
Our study indicates that opium use is not an independent risk factor for CSFP but may exacerbate the severity of coronary artery involvement, noted by a higher incidence of multivessel disease among users. This suggests that opium may affect the extent of coronary artery issues rather than cause CSFP directly.
近期研究表明，鸦片吸食与冠状动脉微血管功能障碍之间可能存在联系，这可能促使冠状动脉慢血流综合征的发生。本研究旨在探究鸦片使用与冠状动脉慢血流综合征之间的关系。
这项回顾性研究分析了2006年至2020年在德黑兰心脏中心接受冠状动脉造影的患者的病历。研究重点关注有冠状动脉慢血流现象（CSFP）或非阻塞性冠状动脉疾病的患者，排除有严重左心室功能障碍（左心室射血分数<40%）、既往冠状动脉血运重建、心律失常或冠状动脉扩张的患者。采用心肌梗死溶栓血流分级和帧数来评估冠状动脉慢血流情况。应用倾向评分匹配和逆概率加权来最小化混杂变量。然后使用条件逻辑回归和逻辑回归模型来检验鸦片使用与冠状动脉慢血流之间的关联，并控制潜在的混杂因素。
在21835例冠状动脉造影正常的患者中，767例被确诊为CSFP，并与3068例对照进行匹配。CSFP患者的平均年龄为51.59岁，男性占64.6%。鸦片使用情况相似，CSFP患者中有8.9%报告使用过鸦片，对照组中有9.5%（p = 0.96）。在CSFP组中，鸦片使用与更广泛的冠状动脉受累相关（33.3%对18.9%，p = 0.03）。初步分析表明，鸦片使用者发生CSFP的风险更高（OR：1.74，p = 0.001），但经过调整后，未发现显著关联（OR：1.06，p = 0.70；OR：1.15，p = 0.55）。
我们的研究表明，鸦片使用不是CSFP的独立危险因素，但可能会加重冠状动脉受累的严重程度，使用者中多支血管疾病的发生率较高表明了这一点。这表明鸦片可能影响冠状动脉问题的程度，而不是直接导致CSFP。
