Cannabis use is associated with increased procedural complexity and need for atherectomy in STEMI despite younger age and lower mortality
D Gerlt, A Al Mubaid, M Mogg, A Abid, B BarrientosAbstract
Background
The impact of cannabis use on ST-elevation myocardial infarction (STEMI) presentation and outcomes is often confounded by the younger demographic of cannabis users. We sought to separate these effects using propensity score matching (PSM) to evaluate whether cannabis use serves as a marker for unique clinical phenotypes regarding procedural complexity, arrhythmia burden, and readmission etiology.
Purpose
To evaluate the impact of cannabis use on in-hospital outcomes and readmissions in patients presenting with a STEMI compared to those who do not use cannabis.
Methods
We queried the Nationwide Readmissions Database (2019–2022) for index STEMI hospitalizations. We compared baseline characteristics, procedural utilisation, and outcomes between cannabis users (CU) and non-users (NU). A 1:1 propensity score matching (PSM) model balanced groups across age, sex, payer, hospital characteristics, and comorbidities (Van Walraven Elixhauser index). Doubly robust regression estimated adjusted odds ratios (aOR) for outcomes.
Results
Of 569,574 weighted hospitalizations, 2.4% (N=13,789) were CUs. In the overall cohort, CUs were significantly younger (median 53 vs 64 years; P<.001) yet exhibited markers of accelerated disease and electrical instability, with higher rates of coronary atherectomy (14.9% vs 12.5%; P=.009) and ventricular tachycardia/fibrillation (22.3% vs 20.0%; P=.149). PSM yielded 7,519 balanced pairs (median age 53 vs 54). In the matched doubly robust analysis, cannabis use remained associated with significantly lower in-hospital mortality (aOR 0.57; 95% CI 0.48-0.68; P<.001). However, this survival advantage was accompanied by higher resource utilisation, including increased hospital charges (Ratio 1.05; P<.001) and length of stay (Ratio 1.03; P=.032). Readmission analysis revealed a distinct divergence with heart failure as the leading cause for NUs (25.3%) while recurrent acute MI (24.0%) and nonspecific chest pain (9.8%) were the primary drivers for CUs.
Conclusion
Cannabis use in STEMI is associated with lower adjusted mortality despite a phenotype of accelerated coronary complexity with higher rates of complex revascularization (atherectomy) and ischemic readmissions rather than heart failure. The associations with increased charges and length of stay suggest that cannabis use complicates the STEMI course, warranting aggressive secondary prevention for recurrent ischemia.