Etienne Puymirat1, Lionel Lamhaut2, Nicolas Bonnet3, Nadia Aissaoui4, Patrick Henry5, Guillaume Cayla6, Simon Cattan7, Gabriel Steg8, Laurent Mock9, Gregory Ducrocq8, Patrick Goldstein10, François Schiele11, Eric Bonnefoy-Cudraz12, Tabassome Simon13, Nicolas Danchin3. 1. Department of Cardiology, European Hospital of Georges Pompidou, Assistance Publique des Hôpitaux de Paris (AP-HP), 15-20 rue Leblanc, Paris 75015, France University Paris Descartes, Paris, France INSERM U-970, Paris, France etiennepuymirat@yahoo.fr etienne.puymirat@egp.aphp.fr. 2. D.A.R. and SAMU de Paris, Hôpital Necker, AP-HP, Paris Descartes University, Paris, France Inserm UMR-S970, Paris Cardiovascular Research Centre, Paris, France. 3. Department of Cardiology, European Hospital of Georges Pompidou, Assistance Publique des Hôpitaux de Paris (AP-HP), 15-20 rue Leblanc, Paris 75015, France University Paris Descartes, Paris, France INSERM U-970, Paris, France. 4. University Paris Descartes, Paris, France European Hospital of Georges Pompidou, Intensive Care unit AP-HP, Paris, France. 5. Department of Cardiology, Hospital Lariboisière, AP-HP, Paris, France. 6. Department of Cardiology, University hospital Carémeau, Nîmes, France. 7. Department of Cardiology, Intercity Hospital Le Raincy-Montfermeil, Montfermeil, France. 8. Department of Cardiology, Hôpital Bichat, AP-HP, Paris, France Sorbonne Paris-Cité, Université Paris-Diderot, Paris 75018, France INSERM U-698, Paris 75018, France. 9. Department of Cardiology, Clinique de Fontaine, Fontaine les Dijon, France. 10. Emergency Department, Lille Regional University Hospital, Lille, France. 11. Department of Cardiology, University Hospital Jean Minjoz, Besançon, France. 12. Department of Cardiology, Hôpital Cardiologique de Lyon, Lyon, France. 13. INSERM U-698, Paris 75018, France Clinical Research Unit (URC) - Est, AP-HP - Hospital Saint Antoine, Paris, France UPMC-Paris 06, Paris, France.
Abstract
AIMS: The use of opioids is recommended for pain relief in patients with myocardial infarction (MI) but may delay antiplatelet agent absorption, potentially leading to decreased treatment efficacy. METHODS AND RESULTS: In-hospital complications (death, non-fatal re-MI, stroke, stent thrombosis, and bleeding) and 1-year survival according to pre-hospital morphine use were assessed in 2438 ST-elevation MI (STEMI) patients from the French Registry of Acute ST-elevation and non-ST-elevation Myocardial Infarction (FAST-MI) 2010. The analyses were replicated in the 1726 STEMI patients of the FAST-MI 2005 cohort, in which polymorphisms of CYP2C19 and ABCB1 had been assessed. Specific subgroup analyses taking into account these genetic polymorphisms were performed in patients pre-treated with thienopyridines. The 453 patients (19%) receiving morphine pre-hospital were younger, more often male, with a lower GRACE score and higher chest pain levels. After adjustment for baseline differences, in-hospital complications and 1-year survival (hazard ratio = 0.69; 95% confidence interval: 0.35-1.37) were not increased according to pre-hospital morphine use. After propensity score matching, 1-year survival according to pre-hospital morphine was also similar. Consistent results were found in the replication cohort, including in those receiving pre-hospital thienopyridines and whatever the genetic polymorphisms of CYP2C19 and ABCB1. CONCLUSION: In two independent everyday-life cohorts, pre-hospital morphine use in STEMI patients was not associated with worse in-hospital complications and 1-year mortality. CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT00673036 (FAST-MI 2005); NCT01237418 (FAST-MI 2010). Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: The use of opioids is recommended for pain relief in patients with myocardial infarction (MI) but may delay antiplatelet agent absorption, potentially leading to decreased treatment efficacy. METHODS AND RESULTS: In-hospital complications (death, non-fatal re-MI, stroke, stent thrombosis, and bleeding) and 1-year survival according to pre-hospital morphine use were assessed in 2438 ST-elevation MI (STEMI) patients from the French Registry of Acute ST-elevation and non-ST-elevation Myocardial Infarction (FAST-MI) 2010. The analyses were replicated in the 1726 STEMI patients of the FAST-MI 2005 cohort, in which polymorphisms of CYP2C19 and ABCB1 had been assessed. Specific subgroup analyses taking into account these genetic polymorphisms were performed in patients pre-treated with thienopyridines. The 453 patients (19%) receiving morphine pre-hospital were younger, more often male, with a lower GRACE score and higher chest pain levels. After adjustment for baseline differences, in-hospital complications and 1-year survival (hazard ratio = 0.69; 95% confidence interval: 0.35-1.37) were not increased according to pre-hospital morphine use. After propensity score matching, 1-year survival according to pre-hospital morphine was also similar. Consistent results were found in the replication cohort, including in those receiving pre-hospital thienopyridines and whatever the genetic polymorphisms of CYP2C19 and ABCB1. CONCLUSION: In two independent everyday-life cohorts, pre-hospital morphine use in STEMI patients was not associated with worse in-hospital complications and 1-year mortality. CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT00673036 (FAST-MI 2005); NCT01237418 (FAST-MI 2010). Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Anne Henrieke Tavenier; Renicus Suffridus Hermanides; Jan Paul Ottervanger; Peter Gerrit Johannes Ter Horst; Elvin Kedhi; Adriaan W J van 't Hof Journal: Drug Saf Date: 2018-12 Impact factor: 5.606
Authors: Jacek Kubica; Piotr Adamski; Jerzy R Ładny; Jarosław Kaźmierczak; Tomasz Fabiszak; Krzysztof J Filipiak; Robert Gajda; Mariusz Gąsior; Zbigniew Gąsior; Robert Gil; Jarosław Gorący; Stefan Grajek; Leszek Gromadziński; Marcin Gruchała; Grzegorz Grześk; Piotr Hoffman; Miłosz J Jaguszewski; Marianna Janion; Piotr Jankowski; Zbigniew Kalarus; Jarosław D Kasprzak; Andrzej Kleinrok; Wacław Kochman; Aldona Kubica; Wiktor Kuliczkowski; Jacek Legutko; Maciej Lesiak; Klaudiusz Nadolny; Eliano P Navarese; Piotr Niezgoda; Małgorzata Ostrowska; Przemysław Paciorek; Jolanta Siller-Matula; Łukasz Szarpak; Dariusz Timler; Adam Witkowski; Wojciech Wojakowski; Andrzej Wysokiński; Marzenna Zielińska Journal: Cardiol J Date: 2022-05-06 Impact factor: 3.487