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Morphine and Ticagrelor Interaction in Primary Percutaneous Coronary Intervention in ST-Segment Elevation Myocardial Infarction: ATLANTIC-Morphine
UF Recherche-Enseignement-Qualité, Université Paris, Hôpital Avicenne, Bobigny, France..
Department of Cardiology, Isala Clinics, Zwolle, The Netherlands, Maastricht University Medical Center, Maastricht, The Netherlands.
Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany.
Service Médical d'Urgence, Brigade de Sapeurs-Pompiers de Paris, Paris, France.
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2019 (English)In: American Journal of Cardiovascular Drugs, ISSN 1175-3277, E-ISSN 1179-187X, Vol. 19, p. 173-183Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Auckland, New Zealand: Adis International Ltd. , 2019. Vol. 19, p. 173-183
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:liu:diva-153878DOI: 10.1007/s40256-018-0305-0ISI: 000460876200005PubMedID: 30353444Scopus ID: 2-s2.0-85055689783OAI: oai:DiVA.org:liu-153878DiVA, id: diva2:1279075
Available from: 2019-01-15 Created: 2019-01-15 Last updated: 2019-04-02Bibliographically approved

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Janzon, Magnus
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Division of Cardiovascular MedicineFaculty of Medicine and Health SciencesDepartment of Cardiology in Linköping
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