PSYCHIATRIC COMORBIDITIES AND IN-HOSPITAL OUTCOMES IN METHAMPHETAMINE-ASSOCIATED MYOCARDIAL INFARCTION: A CASE SERIES

Abstract

Background: Psychiatric disorders are common in methamphetamine use disorder, yet their relationship with in-hospital outcomes after methamphetamine-associated myocardial infarction (MA-MI) has not been examined. This case series describes the prevalence of pre-existing psychiatric diagnoses in MA-MI and explores associated patterns in mortality, revascularization, and discharge disposition. Methods: We reviewed records of 134 consecutive adults (aged 18–75) admitted with a primary diagnosis of acute myocardial infarction and a positive urine methamphetamine screen within 48 hours of admission at a university-affiliated tertiary care center in Handan, China, between 2019 and 2024. Pre-existing psychiatric diagnoses were ascertained by manual chart review and grouped as psychotic, mood, or anxiety disorders. This study is an exploratory case series and was not powered for hypothesis testing. All statistical comparisons are descriptive; p-values, where reported, are unadjusted and not definitive. Results: Fifty patients (37%) had a documented pre-existing psychiatric diagnosis. In-hospital death occurred in 20.0% (10 of 50) of patients with psychiatric comorbidity versus 3.6% (3 of 84) of those without, an absolute risk difference of 16.4 percentage points (95% CI: 4.7%–28.2%). The mortality difference was entirely concentrated in the psychotic-disorder subgroup (10 of 18, 55.6%); no deaths occurred among patients with mood or anxiety disorders. Revascularization was attempted in 44% versus 67% of psychiatric and non-psychiatric patients, respectively (ARD −22.7 percentage points, 95% CI: −39.7% to −5.6%). Findings were directionally similar in a sensitivity analysis restricted to patients with methamphetamine-only toxicology (n=96). Conclusion: This case series documents a 37% prevalence of pre-existing psychiatric comorbidity in MA-MI, with numerically higher mortality and lower revascularization in the psychiatric subgroup. The most extreme risk was concentrated in the psychotic-disorder subset, though the small sample precludes causal inference. These hypothesis-generating observations underscore the need for prospective multicenter investigations.

Keywords: Methamphetamine; myocardial infarction; psychiatric comorbidity; case series; in-hospital mortality; cocaine; polysubstance use