Key result
Cannabis use in STEMI is linked to ~43% lower in-hospital mortality despite higher atherectomy rates.
Why the study?
The impact of cannabis use on STEMI presentation and outcomes is often confounded by the younger demographic of cannabis users, creating uncertainty about its independent association with procedural complexity, arrhythmia burden, in-hospital outcomes, and readmissions.
Does cannabis use affect in-hospital mortality, procedural complexity, and readmission outcomes in patients presenting with STEMI?
Does cannabis use affect in-hospital mortality, procedural complexity, and readmission outcomes in patients presenting with STEMI?
In patients presenting with STEMI, cannabis use is associated with lower adjusted in-hospital mortality but greater procedural complexity (higher atherectomy need), higher resource utilization, and readmissions predominantly for recurrent ischemia rather than heart failure.
Associated lower STEMI mortality with cannabis use may reflect confounding; leaves open causality and should not alter risk stratification.
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.
No takes yet. Share an insight, caveat, or question.
Gerlt et al. (2026) studied this question. Cannabis use in STEMI was associated with higher coronary atherectomy rates (14.9% vs 12.5%; P=.009) despite lower in-hospital mortality (aOR 0.57; P<.001) compared to non-use.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: