TY - JOUR
T1 - Morphine and Ticagrelor Interaction in Primary Percutaneous Coronary Intervention in ST-Segment Elevation Myocardial Infarction
T2 - ATLANTIC-Morphine
AU - the ATLANTIC Investigators
AU - Lapostolle, Frédéric
AU - van’t Hof, Arnoud W.
AU - Hamm, Christian W.
AU - Stibbe, Olivier
AU - Ecollan, Patrick
AU - Collet, Jean Philippe
AU - Silvain, Johanne
AU - Lassen, Jens Flensted
AU - Heutz, Wim M.J.M.
AU - Bolognese, Leonardo
AU - Cantor, Warren J.
AU - Cequier, Angel
AU - Chettibi, Mohamed
AU - Goodman, Shaun G.
AU - Hammett, Christopher J.
AU - Huber, Kurt
AU - Janzon, Magnus
AU - Merkely, Béla
AU - Storey, Robert F.
AU - ten Berg, Jur
AU - Zeymer, Uwe
AU - Licour, Muriel
AU - Tsatsaris, Anne
AU - Montalescot, Gilles
AU - Bougherbal, Rachid
AU - Bouafia, Mohamed Tahar
AU - Nibouche, Djamaleddine
AU - Moklati, Abdelkader
AU - Benalia, Ahmed
AU - Kaid, Omar
AU - Krim, Messaad
AU - Garraby, Paul
AU - Jayasinghe, Rohan
AU - Rashford, Stephen
AU - Neunteufl, Thomas
AU - Brussee, Helmut
AU - Alber, Hannes
AU - Weidinger, Franz
AU - Brunner, Michael
AU - Sipoetz, Johann
AU - Prause, Gerhard
AU - Baubin, Michael
AU - Sebald, Dieter
AU - Vijayaraghavan, Ram
AU - Bata, Iqbal
AU - Lavoie, Andrea
AU - Ravkilde, Jan
AU - Jensen, Lisette Okkels
AU - Christensen, Alf Møl
AU - Seyfarth, Melchior
N1 - Publisher Copyright:
© 2018, Springer Nature Switzerland AG.
PY - 2019/4/8
Y1 - 2019/4/8
N2 - 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.
AB - 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.
UR - https://www.scopus.com/pages/publications/85055689783
U2 - 10.1007/s40256-018-0305-0
DO - 10.1007/s40256-018-0305-0
M3 - Article
C2 - 30353444
AN - SCOPUS:85055689783
SN - 1175-3277
VL - 19
SP - 173
EP - 183
JO - American Journal of Cardiovascular Drugs
JF - American Journal of Cardiovascular Drugs
IS - 2
ER -