Opium consumption after CABG increases risk for mortality, CVD events
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The risk for mortality, ACS and major adverse cardio-cerebrovascular events increased throughout 5 years in patients who continued opium consumption after CABG, researchers found.
“The first outpatient visit after bypass surgery is a sensible time to start talking about stopping the use of opium,” Farzad Masoudkabir, MD, assistant professor in the department of cardiology at Tehran University of Medical Sciences in Iran, said in a press release. “This gives patients about 1 month to recover from the physical stress of the operation before commencing withdrawal.”
CABG in Tehran
In this study published in the European Journal of Preventive Cardiology, researchers analyzed data from 28,691 patients (mean age, 61 years; 73% men) from the CABG Follow-Up Registry of Tehran Heart Center who underwent surgery between 2007 and 2016. Patients were categorized by their status of opium consumption, which included smoking the substance or drinking it in tea: never consumers (n = 23,619), consumed constantly or intermittently after CABG (n = 3,636) or underwent opium cessation (n = 1,436).
“According to the United Nations Office on Drugs and Crime, in 2015, approximately 17.7 million people used opium or its derivatives illicitly worldwide,” Masoudkabir and colleagues wrote. “Opium is still the most commonly consumed substance after tobacco in the developing countries of the Middle East and many Asian countries.”
Follow-up was conducted at 6 and 12 months and then annually for a median of 55.95 months. During follow-up, researchers collected information on demographic characteristics, laboratory findings, CVD risk factors and the occurrence of major adverse cardio-cerebrovascular events, defined as a composite of ACS, all-cause mortality, repeat revascularization, stroke or transient ischemic attack. The primary composite endpoint was major adverse cardio-cerebrovascular events. Secondary endpoints consisted of all-cause mortality and ACS.
At 5 years, all-cause mortality occurred in 9.7% of patients in the never-opium consumer group, 10.2% of those in the persistent postoperative opium consumption group and 5.3% of patients in the enduring postoperative opium withdrawal group (P < .001). During follow-up, major adverse cardiac-cerebrovascular events occurred in 18.7% of patients in the never-opium consumers group, 20.2% of those in the persistent postoperative opium consumers group and 14.8% of patients in the enduring postoperative opium withdrawal group (P < .0001).
Increased risk with opium use
Multivariable survival analysis determined that patients with persistent opium consumption after CABG had a 28% increased risk for 5-year mortality (HR = 1.28; 95% CI, 1.06-1.54) and a 25% increased risk for major adverse cardio-cerebrovascular events at 5 years (HR = 1.25; 95% CI, 1.13-1.4). This analysis also found that the risk for ACS increased by 34% in these patients (subdistribution HR = 1.34; 95% CI, 1.16-1.55).
The link between opium consumption and the incidence of cerebrovascular accident and repeat revascularization was not statistically significant.
“These findings indicate that, contrary to the common concern among cardiac surgeons and cardiologists that stopping opium consumption after CABG might trigger acute cardiovascular events, opium withdrawal is safe and is associated with a decreased risk of mortality, [major adverse cardio-cerebrovascular events] and ACS,” Masoudkabir and colleagues wrote. “Cardiologists and cardiac surgeons should be informed about the safety and beneficial effects of opium cessation and encourage their opium-consuming patients to participate in opium withdrawal programs.”
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