In-hospital outcomes in invasively managed acute myocardial infarction patients who receive morphine

We aimed to analyze the association between morphine and in-hospital outcomes in invasively managed ST elevation myocardial infarction (STEMI) and non-ST elevation acute coronary syndrome (NSTE-ACS) patients. Morphine is commonly used for analgesia in the setting of acute coronary syndromes (ACS); h...

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Bibliographic Details
Published in:Journal of interventional cardiology Vol. 31; no. 2; p. 150
Main Authors: McCarthy, Cian P, Bhambhani, Vijeta, Pomerantsev, Eugene, Wasfy, Jason H
Format: Journal Article
Language:English
Published: United States 01.04.2018
Subjects:
Acute Coronary Syndrome - diagnosis
Acute Coronary Syndrome - drug therapy
Acute Coronary Syndrome - mortality
Acute Coronary Syndrome - surgery
Aged
Analgesics, Opioid - administration & dosage
Analgesics, Opioid - adverse effects
Female
Hospital Mortality
Humans
Length of Stay
Male
Middle Aged
Morphine - administration & dosage
Morphine - adverse effects
Odds Ratio
Outcome and Process Assessment, Health Care
Percutaneous Coronary Intervention - adverse effects
Percutaneous Coronary Intervention - methods
Retrospective Studies
ST Elevation Myocardial Infarction - diagnosis
ST Elevation Myocardial Infarction - drug therapy
ST Elevation Myocardial Infarction - mortality
ST Elevation Myocardial Infarction - surgery
United States - epidemiology
United States
STEMI
NTE-ACS
morphine
ISSN:1540-8183, 1540-8183
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Summary:We aimed to analyze the association between morphine and in-hospital outcomes in invasively managed ST elevation myocardial infarction (STEMI) and non-ST elevation acute coronary syndrome (NSTE-ACS) patients. Morphine is commonly used for analgesia in the setting of acute coronary syndromes (ACS); however, recently its utility in ACS has come under closer scrutiny. We identified all STEMI and NSTE-ACS patients undergoing coronary angiogram +/- percutaneous intervention between January 2009 and July 2016 in our center and recorded patient characteristics and inpatient outcomes. Overall, 3027 patients were examined. Overall, STEMI patients who received morphine had no difference in in-hospital mortality [4.18% vs. 7.54%, odds ratio (OR): 0.36, P = 0.19], infarct size (mean troponin level 0.75 ng/mL vs. 1.29 ng/mL, P = 0.32) or length of hospital stay (P = 0.61). The NSTE-ACS patients who received morphine had a longer hospital stay (mean 6.58 days vs. 4.78 days, P < 0.0001) and larger infarct size (mean troponin 1.16 ng/mL vs. 0.90 ng/mL, P = 0.02). Comparing matched patients, the use of morphine was associated with larger infarct size (mean troponin 1.14 ± 1.92 ng/mL vs. 0.83 ± 1.49 ng/mL, P = 0.01), longer hospital stay (6.5 ± 6.82 days vs. 4.89 ± 5.36 days, P = 0.004) and a trend towards increased mortality (5% vs. 2%, OR: 2.55, P = 0.06) in NSTE-ACS patients but morphine did not affect outcomes in the propensity matched STEMI patients. In a large retrospective study, morphine was associated with larger infarct size, a longer hospital stay and a trend towards increased mortality in invasively managed NSTE-ACS patients even after adjustment for clinical characteristics.
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ISSN:1540-8183
1540-8183
DOI:10.1111/joic.12464