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Abstract BACKGROUND: The aim of this study was to assess resolution of ST segment elevation after streptokinase therapy in opium-addict patients with acute myocardial infarction (AMI). METHOD AND MATERIALS: The studied population consisted of AMI patients who have criteria for thrombolytic therapy. Three groups of ST segment resolution were defined: complete resolution (≥ 70%), partial resolution (70% to 30%) and no resolution (< 30%). RESULTS: A total number of 240 patients were studied (126 opium addicts and 114 non-addicts). Overall, 52.5% of addicts and 38.7% of non-addicts had complete ST segment resolution (P = 0.06). The odds of ST elevation resolution in addicts was 1.8 (95%, CI: 1.09-2.95) compared to non-addicts. When it was adjusted for other variables, it reduced to 1.03 (95%, CI: 0.54-1.97). CONCLUSION: There was not any significant relationship between opium addiction and response to thrombolytic therapy among patients with acute MI. Keywords: Acute myocardial infarction, opium, streptokinase, substance abuse.