Frédéric Lapostolle1, Arnoud W Van't Hof2,3, Christian W Hamm4, Olivier Stibbe5, Patrick Ecollan6, Jean-Philippe Collet6, Johanne Silvain6, Jens Flensted Lassen7, Wim M J M Heutz8, Leonardo Bolognese9, Warren J Cantor10, Angel Cequier11, Mohamed Chettibi12, Shaun G Goodman13, Christopher J Hammett14, Kurt Huber15, Magnus Janzon16, Béla Merkely17, Robert F Storey18, Jur Ten Berg19, Uwe Zeymer20, Muriel Licour21, Anne Tsatsaris21, Gilles Montalescot22. 1. SAMU 93 - UF Recherche-Enseignement-Qualité, Université Paris 13, Sorbonne Paris Cité, Inserm U942, Hôpital Avicenne, 125, rue de Stalingrad, 93009, Bobigny, France. 2. Department of Cardiology, Isala Clinics, Zwolle, The Netherlands. 3. Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands. 4. Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany. 5. Service Médical d'Urgence, Brigade de Sapeurs-Pompiers de Paris, Paris, France. 6. Sorbonne Université, ACTION Study Group, Hôpital Pitié-Salpêtrière (AP-HP), 47 boul de l'Hôpital, 75013, Paris, France. 7. Department of Cardiology B, Aarhus University Hospital, Skejby, Aarhus N, Denmark. 8. Regionale Ambulance Voor ziening Gelderland-Midden, Arnhem, The Netherlands. 9. Cardiovascular and Neurological Department, Azienda Ospedaliera Arezzo, Arezzo, Italy. 10. Southlake Regional Health Centre, University of Toronto, Newmarket, ON, Canada. 11. Heart Disease Institute, Hospital Universitario de Bellvitge, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain. 12. Centre Hospito-universitaire Frantz Fanon, Blida, Algeria. 13. Division of Cardiology, Canadian Heart Research Centre, St Michael's Hospital, University of Toronto, Toronto, Canada. 14. Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia. 15. 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Wilhelminenhospital, Sigmund Freud University, Medical School, Vienna, Austria. 16. Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden. 17. Heart and Vascular Center, Semmelweis University, Budapest, Hungary. 18. Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK. 19. Department of Cardiology, St Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands. 20. Klinikum Ludwigshafen and Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany. 21. AstraZeneca, Rueil Malmaison, France. 22. Sorbonne Université, ACTION Study Group, Hôpital Pitié-Salpêtrière (AP-HP), 47 boul de l'Hôpital, 75013, Paris, France. gilles.montalescot@aphp.fr.
Abstract
BACKGROUND:Morphine adversely impacts the action of oral adenosine diphosphate (ADP)-receptor blockers in ST-segment elevation myocardial infarction (STEMI) patients, and is possibly associated with differing patient characteristics. This retrospective analysis investigated whether interaction between morphine use and pre-percutaneous coronary intervention (pre-PCI) ST-segment elevation resolution in STEMI patients in the ATLANTIC study was associated with differences in patient characteristics and management. METHODS: ATLANTIC was an international, multicenter, randomized study of treatment in the acute ambulance/hospital setting where STEMI patients received ticagrelor 180 mg ± morphine. Patient characteristics, cardiovascular history, risk factors, management, and outcomes were recorded. RESULTS: Opioids (97.6% morphine) were used in 921 out of 1862 patients (49.5%). There were no significant differences in age, sex or cardiovascular history, but more morphine-treated patients had anterior myocardial infarction and left-main disease. Time from chest pain to electrocardiogram and ticagrelor loading was shorter with morphine (both p = 0.01) but not total ischemic time. Morphine-treated patients more frequently received glycoprotein IIb/IIIa inhibitors (p = 0.002), thromboaspiration and stent implantation (both p < 0.001). No significant difference between the two groups was found regarding pre-PCI ≥ 70% ST-segment elevation resolution, death, myocardial infarction, stroke, urgent revascularization and definitive acute stent thrombosis. More morphine-treated patients had an absence of pre-PCI Thrombolysis in Myocardial Infarction (TIMI) 3 flow (85.8% vs. 79.7%; p = 0.001) and more had TIMI major bleeding (1.1% vs. 0.1%; p = 0.02). CONCLUSIONS:Morphine-treatment was associated with increased GP IIb/IIIa inhibitor use, less pre-PCI TIMI 3 flow, and more bleeding. Judicious morphine use is advised with non-opioid analgesics preferred for non-severe acute pain. TRIAL REGISTRATION: clinicaltrials.gov identifier: NCT01347580.
RCT Entities:
BACKGROUND:Morphine adversely impacts the action of oral adenosine diphosphate (ADP)-receptor blockers in ST-segment elevation myocardial infarction (STEMI) patients, and is possibly associated with differing patient characteristics. This retrospective analysis investigated whether interaction between morphine use and pre-percutaneous coronary intervention (pre-PCI) ST-segment elevation resolution in STEMI patients in the ATLANTIC study was associated with differences in patient characteristics and management. METHODS: ATLANTIC was an international, multicenter, randomized study of treatment in the acute ambulance/hospital setting where STEMI patients received ticagrelor 180 mg ± morphine. Patient characteristics, cardiovascular history, risk factors, management, and outcomes were recorded. RESULTS: Opioids (97.6% morphine) were used in 921 out of 1862 patients (49.5%). There were no significant differences in age, sex or cardiovascular history, but more morphine-treated patients had anterior myocardial infarction and left-main disease. Time from chest pain to electrocardiogram and ticagrelor loading was shorter with morphine (both p = 0.01) but not total ischemic time. Morphine-treated patients more frequently received glycoprotein IIb/IIIa inhibitors (p = 0.002), thromboaspiration and stent implantation (both p < 0.001). No significant difference between the two groups was found regarding pre-PCI ≥ 70% ST-segment elevation resolution, death, myocardial infarction, stroke, urgent revascularization and definitive acute stent thrombosis. More morphine-treated patients had an absence of pre-PCI Thrombolysis in Myocardial Infarction (TIMI) 3 flow (85.8% vs. 79.7%; p = 0.001) and more had TIMI major bleeding (1.1% vs. 0.1%; p = 0.02). CONCLUSIONS:Morphine-treatment was associated with increased GP IIb/IIIa inhibitor use, less pre-PCI TIMI 3 flow, and more bleeding. Judicious morphine use is advised with non-opioid analgesics preferred for non-severe acute pain. TRIAL REGISTRATION: clinicaltrials.gov identifier: NCT01347580.
Authors: Anne H Tavenier; Renicus S Hermanides; Jan Paul Ottervanger; Rudolf Tolsma; Antony van Beurden; Robbert Jan Slingerland; Peter G J Ter Horst; A T Marcel Gosselink; Jan-Henk E Dambrink; Maarten A H van Leeuwen; Vincent Roolvink; Elvin Kedhi; Olaf H Klungel; Svetlana V Belitser; Dominick J Angiolillo; Tobias Pustjens; Saman Rasoul; Ben Gho; Mera Stein; Lex Ruiters; Arnoud W J van 't Hof Journal: Eur Heart J Cardiovasc Pharmacother Date: 2022-01-05