Morphine and Cardiovascular Outcomes Among Patients With Non-ST-Segment Elevation Acute Coronary Syndromes Undergoing Coronary Angiography

Mechanistic studies have shown that morphine blunts the antiplatelet effects of oral adenosine diphosphate receptor blockers. However, the clinical relevance of this interaction is controversial. This study sought to explore the association between morphine and ischemic events in 5,438 patients trea...

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Bibliographic Details
Published in:Journal of the American College of Cardiology 2020-01, Vol.75 (3), p.289-300
Main Authors: Furtado, Remo H.M., Nicolau, José C., Guo, Jianping, Im, Kyungah, White, Jennifer A., Sabatine, Marc S., Newby, L. Kristin, Giugliano, Robert P.
Format: Article
Language:English
Subjects:
Acute coronary syndromes
Adenosine
Adenosine diphosphate
ADP receptor blocker
Angiography
Angioplasty
Cardiology
Clopidogrel
Confidence intervals
Control methods
Death
Disorders
Drug dosages
drug interaction
Electrocardiography
Glycoproteins
Heart attacks
Ischemia
Medical imaging
Morphine
Mortality
Myocardial infarction
Narcotics
non-ST-segment elevation ACS
opioids
Patients
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Summary:Mechanistic studies have shown that morphine blunts the antiplatelet effects of oral adenosine diphosphate receptor blockers. However, the clinical relevance of this interaction is controversial. This study sought to explore the association between morphine and ischemic events in 5,438 patients treated with concomitant clopidogrel presenting with non-ST-segment elevation acute coronary syndromes (NSTEACS) in the EARLY ACS (Early Glycoprotein IIb/IIIa Inhibition in Patients With Non–ST-Segment Elevation Acute Coronary Syndrome) trial. Patients not treated with clopidogrel (n = 3,462) were used as negative controls. Endpoints were the composite of death, myocardial infarction (MI), recurrent ischemia, or thrombotic bailout at 96 h (4-way endpoint) and the composite of death or MI at 30 days. In patients treated with clopidogrel, morphine use was associated with higher rates of the 4-way endpoint at 96 h (adjusted odds ratio [OR]: 1.40; 95% confidence interval [CI]: 1.04 to 1.87; p = 0.026). There was a trend for higher rates of death or MI at 30 days (adjusted OR: 1.29; 95% CI: 0.98 to 1.70; p = 0.072), driven by events in the first 48 h (adjusted hazard ratio: 1.54; 95% CI: 1.07 to 2.23; p = 0.021). In patients not treated with clopidogrel, morphine was not associated with either the 4-way endpoint at 96 h (adjusted OR: 1.05; 95% CI: 0.74 to 1.49; p = 0.79; pinteraction = 0.36 ) or death or MI at 30 days (adjusted OR: 1.07; 95% CI: 0.77 to 1.48; p = 0.70; pinteraction = 0.46). When used concomitantly with clopidogrel pre-treatment, morphine was associated with higher rates of ischemic events in patients with NSTEACS. (EARLY ACS: Early Glycoprotein IIb/IIIa Inhibition in Patients With Non–ST-Segment Elevation Acute Coronary Syndrome; NCT00089895) [Display omitted]
ISSN:0735-1097
1558-3597
DOI:10.1016/j.jacc.2019.11.035