Angiographic and early in-hospital profile of primary percutaneous coronary intervention in patients with substance use disorder presenting with ST-segment elevation myocardial infarction.

Acute myocardial infarction is increasingly recognized in younger adults, but the angiographic and early clinical profile of ST-segment elevation myocardial infarction among patients with substance use disorder remains incompletely defined. This single-center prospective observational cohort study evaluated the angiographic and early in-hospital profile after primary percutaneous coronary intervention in patients with and without substance use disorder. A total of 175 patients formed the final analytic cohort, including 75 patients with substance use disorder confirmed by DSM-5 criteria supported by point-of-care urine toxicology screening and 100 patients without substance use disorder. Patients with substance use disorder were younger, exclusively male, and had fewer traditional cardiometabolic co-morbidities. In unadjusted analyses, they more often had single-vessel coronary disease and more frequent glycoprotein IIb/IIIa inhibitor use, whereas angiographic thrombus presence was similarly frequent in both groups. After multivariable adjustment, the associations with single-vessel disease and glycoprotein IIb/IIIa inhibitor use were not statistically robust. Patients with substance use disorder presented with a distinct baseline and procedural profile, but adjusted analyses did not support an independent association with the principal angiographic or procedural outcomes assessed, supporting careful toxicology assessment and thrombus-focused procedural planning while avoiding causal interpretation.