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This single-center prospective observational cohort study evaluated the angiographic and early in-hospital profile after primary percutaneous coronary intervention in patients with and without substance use disorder. A total of 175 patients formed the final analytic cohort, including 75 patients with substance use disorder confirmed by DSM-5 criteria supported by point-of-care urine toxicology screening and 100 patients without substance use disorder. Patients with substance use disorder were younger, exclusively male, and had fewer traditional cardiometabolic co-morbidities. In unadjusted analyses, they more often had single-vessel coronary disease and more frequent glycoprotein IIb\/IIIa inhibitor use, whereas angiographic thrombus presence was similarly frequent in both groups. After multivariable adjustment, the associations with single-vessel disease and glycoprotein IIb\/IIIa inhibitor use were not statistically robust. Patients with substance use disorder presented with a distinct baseline and procedural profile, but adjusted analyses did not support an independent association with the principal angiographic or procedural outcomes assessed, supporting careful toxicology assessment and thrombus-focused procedural planning while avoiding causal interpretation.<\/jats:p>","DOI":"10.1038\/s41598-026-65981-9","type":"journal-article","created":{"date-parts":[[2026,8,15]],"date-time":"2026-08-15T09:44:07Z","timestamp":1786787047000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Angiographic and early in-hospital profile of primary percutaneous coronary intervention in patients with substance use disorder presenting with ST-segment elevation myocardial infarction"],"prefix":"10.1038","volume":"16","author":[{"given":"Khaled M.","family":"Elmaghraby","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdalla A.","family":"Gamal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hatem Abdel Rahman","family":"Helmy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yousra","family":"Ghzally","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,15]]},"reference":[{"issue":"12","key":"65981_CR1","doi-asserted-by":"publisher","first-page":"728","DOI":"10.4330\/wjc.v8.i12.728","volume":"8","author":"A Aggarwal","year":"2016","unstructured":"Aggarwal, A., Srivastava, S. & Velmurugan, M. 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