Morphine and Ticagrelor Interaction in Primary Percutaneous Coronary Intervention in ST-Segment Elevation Myocardial Infarction: ATLANTIC-Morphine
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van't Hof, Arnoud W
Hamm, Christian W
Stibbe, Olivier
Ecollan, Patrick
Collet, Jean-Philippe
Silvain, Johanne
Lassen, Jens Flensted
Heutz, Wim MJM
Bolognese, Leonardo
Cantor, Warren J
Cequier, Angel
Chettibi, Mohamed
Jayasinghe, Rohan
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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.
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American Journal of Cardiovascular Drugs
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19
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2
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Cardiovascular medicine and haematology
Science & Technology
Life Sciences & Biomedicine
Cardiac & Cardiovascular Systems
Pharmacology & Pharmacy
Cardiovascular System & Cardiology
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Lapostolle, F; van't Hof, AW; Hamm, CW; Stibbe, O; Ecollan, P; Collet, J-P; Silvain, J; Lassen, JF; Heutz, WMJM; Bolognese, L; Cantor, WJ; Cequier, A; Chettibi, M; Goodman, SG; Hammett, CJ; Huber, K; Janzon, M; Merkely, B; Storey, RF; ten Berg, J; Zeymer, U; Licour, M; Tsatsaris, A; Montalescot, G; Bougherbal, R; Bouafia, MT; Chettibi, M; Nibouche, D; Moklati, A; Benalia, A; Krim, M; Hammett, C; Garraby, P; Jayasinghe, R; Rashford, S; Huber, K; Neunteufl, T; Brussee, H; Alber, H; Weidinger, F; Baubin, M; Sebald, D; Cantor, W; Vijayaraghavan, R; Bata, I; Lavoie, A; Lassen, JF; Ravkilde, J; Jensen, LO; Christensen, AM; Toftegaard, M; Kohler, D; Montalescot, G; Ducrocq, G; Danchin, N; Henry, P; Livarek, B; Berthier, R; Hovasse, T; Garot, P; Payot, L; Benamer, H; Esteve, JB; Elhadad, S; Teiger, E; Bonnet, JL; Paganelli, F; Cottin, Y; Schiele, F; Thuaire, C; Cayla, G; Coste, P; Ohlmann, P; Cudraz, EB; Lantelme, P; Perret, T; Tron, C; De labriolle, A; Aptecar, E; Beliard, O; Varenne, O; El Mahmoud, R; Filippi-Codaccioni, E; Angoulvant, D; Peycher, P; Poitrineau, O; Tabone, X; Ecollan, P; Broche, C; Lambert, Y; Briole, N; Beruben, A; Porcher, N; Auffray, J-P; Freysz, M; Depardieu, F; Poubel, D; De La Cousaye, J-E; Bartier, J-C; Jardel, B; Boulanger, B; Labourel, H; Soulat, L-C; Lapostolle, F; Julie, V; Thicoipe, M; Capel, O; Stibbe, O; Carli, P; Tazarourte, K; Alcouffe, F; Aboucaya, D; Aubert, G; Kierzek, G; Cahun-Giraud, S; Zeymer, U; Hamm, C; Dengler, T; Prondzinsky, R; Biever, PM; Schafer, A; Seyfarth, M; Lemke, B; Werner, G; Nef, H; Steiger, H; Leschke, M; Munzel, T; Orto, MCD; Loges, C; Schinke, M; Koberne, F; Reiffen, HP; Tiroch, K; Wierich, D; Kneussel, M; Little, S; Sauer, H; Laufenberg-Feldmann, R; Merkely, B; Ungi, I; Horvath, I; Edes, I; Martai, I; Bolognese, L; Berti, S; Chiarella, F; Calabria, P; Fineschi, M; Galvani, M; Valgimigli, M; Moretti, L; Tespili, M; Mando, M; Bermano, F; Biagioni, R; Fabbri, A; Ricciardelli, A; Petroni, MR; Vatteroni, UR; Palumbo, F; Willems, FF; Al Mafragi, A; Heestermans, TAACM; Van Eck, MJ; Heutz, WMJM; Meppelder, HH; Jong, AR-D; Van de Pas, H; Fillat, AC; Sabate Tenas, M; Mauri Ferrer, J; Serra Penaranda, A; Angel Ferrer, J; Garcia Del Blanco, B; Miranda Guardiola, F; Ruiz Nodar, JM; Iniguez Romo, A; Vazquez Gonzalez, N; Trillo Nouche, R; Diaz De La Llera, L; Hernandez Garcia, JM; Rivero-Crespo, F; Hernandez Hernandez, F; Luis Zamorano, J; Jimenez Farega, X; Alonso Fernandez, G; Luis Toboso, J; Carrasco, M; Barreiro, V; Iglesias Vazquez, JA; Ruiz Montero, MDM; Rosell Ortiz, F; Garcia Escudero, G; Sanchez-Brunete Ingelmo, V; Lara Garcia, A; Janzon, M; Oldgren, J; Calais, F; Kastberg, R; Bergsten, P-A; Blomberg, H; Thorn, K; Skoog, G; Storey, RF; Zaman, A; Gerber, R; Ryding, A; Spence, M; Swanson, N; Been, M; Grosser, K; Schofield, P; Mackin, D; Fell, P; Quinn, T; Foster, T; McManus, D; Carson, A, Morphine and Ticagrelor Interaction in Primary Percutaneous Coronary Intervention in ST-Segment Elevation Myocardial Infarction: ATLANTIC-Morphine, American Journal of Cardiovascular Drugs 2019, 19 (2), pp. 173-183