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Updated: Jan 29, 2026
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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
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Opioids and ST Elevation Myocardial Infarction: A Systematic Review.
Ji Quan Samuel Koh1, Himawan Fernando2, Karlheinz Peter3
1Alfred Hospital, Melbourne, Vic, Australia.
Heart, Lung & Circulation
|February 13, 2019
Summary
Parenteral opioids may delay antiplatelet agents in ST-Elevation Myocardial Infarction (STEMI) patients. While opioids are linked to increased platelet reactivity, their impact on major adverse cardiac events (MACE) requires further investigation in large trials.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Opioids are traditionally used for pain relief in ST-Elevation Myocardial Infarction (STEMI).
- Emerging evidence suggests potential harm from opioids, possibly delaying antiplatelet medication efficacy.
Purpose of the Study:
- To systematically review the clinical and pharmacological effects of parenteral opioids in STEMI patients.
Main Methods:
- Systematic search of medical databases up to February 2018.
- Inclusion of randomized controlled trials (RCTs) and observational studies comparing opioid vs. no opioid administration in STEMI.
- Evaluation of in-hospital, 30-day, and one-year major adverse cardiac events (MACE) and platelet reactivity, using GRADE criteria.
Main Results:
- One high-quality RCT (pharmacokinetics, small sample) and 17 low-to-moderate quality observational studies were identified.
- Opioid use was associated with increased platelet reactivity in most studies.
- Clinical outcomes (MACE) data were equivocal.
Conclusions:
- A significant lack of high-quality research exists on opioid effects in STEMI.
- Opioids appear to prolong platelet reactivity, but the clinical significance for MACE is uncertain.
- Urgent need for large, powered trials to assess opioid safety in STEMI management.
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