Effects of opium use on one-year major adverse cardiovascular events (MACE) in the patients with ST-segment elevation MI undergoing primary PCI: a propensity score matched - machine learning based study

Abstract

Background Considerable number of people still use opium worldwide and many believe in opium’s health benefits. However, several studies proved the detrimental effects of opium on the body, especially the cardiovascular system. Herein, we aimed to provide the first evidence regarding the effects of opium use on one-year major adverse cardiovascular events (MACE) in the patients with ST-elevation MI (STEMI) who underwent primary PCI. Methods We performed a propensity score matching of 2:1 (controls: opium users) that yielded 518 opium users and 1036 controls. Then, we performed conventional statistical and machine learning analyses on these matched cohorts. Regarding the conventional analysis, we performed multivariate analysis for hazard ratio (HR) of different variables and MACE and plotted Kaplan Meier curves. In the machine learning section, we used two tree-based ensemble algorithms, Survival Random Forest and XGboost for survival analysis. Variable importance (VIMP), tree minimal depth, and variable hunting were used to identify the importance of opium among other variables. Results Opium users experienced more one-year MACE than their counterparts, although it did not reach statistical significance (Opium: 72/518 (13.9%), Control: 112/1036 (10.8%), HR: 1.27 (95% CI: 0.94–1.71), adjusted p-value = 0.136). Survival random forest algorithm ranked opium use as 13th, 13th, and 12th among 26 variables, in variable importance, minimal depth, and variable hunting, respectively. XGboost revealed opium use as the 12th important variable. Partial dependence plot demonstrated that opium users had more one-year MACE compared to non-opium-users. Conclusions Opium had no protective effects on one-year MACE after primary PCI on patients with STEMI. Machine learning and one-year MACE analysis revealed some evidence of its possible detrimental effects, although the evidence was not strong and significant. As we observed no strong evidence on protective or detrimental effects of opium, future STEMI guidelines may provide similar strategies for opium and non-opium users, pending the results of forthcoming studies. Governments should increase the public awareness regarding the evidence for non-beneficial or detrimental effects of opium on various diseases, including the outcomes of primary PCI, to dissuade many users from relying on false beliefs about opium’s benefits to continue its consumption.

Prediabetes and major adverse cardiac events after acute coronary syndrome: An overestimated concept

“…Hyperglycemia can cause the incidence of the MACCE after PCI through some mechanisms such as increased oxidative stress, advanced glycation end products (AGEs), platelet activation, impaired endothelial function, and increased inflammatory response causing the development of atherosclerosis. 29 , 30 , 31 AGEs are produced at an augmented rate, which causes oxidative stress and inflammation, which in turn causes endothelial dysfunction and accelerates atherosclerosis. 30 Moreover, activation of protein kinase C isoforms also compromises nitric oxide signaling.…”

“…Primary outcomes were a composite of MACCE (i.e., all‐cause mortality, myocardial infarction [MI], stroke, target vessel revascularization [TVR], target lesion revascularization [TLR], and CABG) as used in Tehran Heart Center studies. 29 TLR was defined as repeat PCI within the index procedure stent or 5 mm edge. In our study, TVR cases were those for whom repeat PCI was performed in the target vessel but in another site than the target lesion.…”

“…28 Patients not fulfilling any of these two criteria were considered NG. Baseline 29 TLR was defined as repeat PCI within the index procedure stent or 5 mm edge. In our study, TVR cases were those for whom repeat PCI was performed in the target vessel but in another site than the target lesion.…”

The association between metabolic syndrome and major adverse cardiac and cerebrovascular events in patients with acute coronary syndrome undergoing percutaneous coronary intervention

“…The primary outcome of the study was MACCE, defined as a composite of all-cause mortality, myocardial infarction, target lesion revascularization (TLR), target vessel revascularization (TVR), CABG, and stroke/cerebrovascular events, as used in previous studies at the Tehran Heart Center 24 . The secondary outcomes were individual MACCE components.…”