Heightened Mortality and Clinical Risks in Patients With Substance Use Disorder Undergoing Cardiac Catheterization

Background Healthcare disparities significantly affect patients with substance use disorder (SUD), particularly in cardiovascular disease (CVD). Although SUD is linked to poorer outcomes, research comparing SUD patients’ clinical and procedural outcomes during cardiac catheterization to non‐SUD controls is limited. This study aims to address this gap. Methods A retrospective 1:2 case‐control study at University Hospital (UH) from 2008 to 2022 included 102 patients with SUD and 203 age‐ and sex‐matched controls without SUD who underwent cardiac catheterization selected from the Cardiac Catheterization and Percutaneous Intervention (CAPIT) registry. Matching and exclusion criteria were applied, with additional data collected via chart review. The study was approved by the Rutgers Institutional Review Board. Results 102 patients with SUD and 203 patients without SUD who underwent cardiac catheterization from 2008 to 2022 were compared. Of the SUD group, 52.4% used both heroin and cocaine and 23.8% had a history of intravenous drug use (IVDU). SUD patients were more likely to have an ejection fraction of less than 30% around 1 year or more after procedure (13.7% vs. 3.4%, p = 0.001), be designated as NYHA Class 3‐4 (23.5% vs. 8.9%, p ≤ 0.001), have arrythmia (5.9% vs. 1.0%, p = 0.019), require mechanical ventilation (11.8% vs. 5.4%, p = 0.048), and have increased mortality (24.5% vs. 12.3%, p = 0.007) as shown in the tables. SUD was associated with significantly worse survival (estimated mean survival: 9.33 [95% CI 7.83–10.84] in the SUD group vs. 12.22 [95% CI 10.13–14.30] years, log rank p = 0.005 in the non‐SUD group). SUD was an independent positive predictor of death (OR = 2.28, 95%, 1.09–4.76, p = 0.029). Conclusions Patients with SUD undergoing cardiac catheterization face heightened risks, including increased mortality, reduced ejection fraction, arrhythmias, mechanical ventilation, and shorter survival. These findings highlight the urgent need for targeted, multidisciplinary action to address disparities in this vulnerable population.