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Impact of periprocedural morphine use on mortality in STEMI patients treated with primary PCI
Dominika Domokos1, Andras Szabo2, Gyongyver Banhegyi3
1Heart and Vascular Center, Semmelweis University, Budapest, Hungary.
Background:
Intravenous morphine (MO) decreases the effect of all oral platelet P2Y12 receptor inhibitors in vitro and observational reports suggest that its use may be associated with larger infarct size. Yet, there are limited data available about the impact of this interaction on clinical outcomes. We studied the effect of MO on mortality in ST-segment elevation myocardial infarction (STEMI) patients treated with primary PCI using a prospective registry.
Methods:
Of the 1255 patients who underwent primary PCI, 397 received MO based on physician's judgment. Clopidogrel was used as P2Y12 receptor antagonist in all cases. Median follow-up time was 7.5 years with 457 deaths. To adjust for confounding, two propensity score-based procedures were performed: 1 to 1 matching (PSM, 728 cases), and inverse probability of treatment weighting (IPTW) retaining data from all patients. Primary outcome measure was time to all-cause death, whereas predischarge left ventricular ejection fraction (LVEF) was used as secondary end point.
Results:
An adequate balance on baseline covariates was achieved by both methods. We found no difference in survival as the HR (MO/no MO) was 0.98 (95% confidence interval [CI]: 0.76-1.26), p = 0.86 using PSM and 1.01 (95% CI: 0.84-1.23), p = 0.88 with IPTW. Likewise, distributions of LVEFs were similar using either methods: with PSM, median LVEFs were 50.0% (interquartile range [IQR]: 43.0%-55.3%) vs 50.0% (IQR: 42.0%-55.0%) in the no MO and MO groups, respectively (p = 0.76), whereas using IPTW, they were 50.0% (IQR: 42.5%-55.0%) vs 50.0% (IQR: 41.0%-55.0%), respectively (p = 0.86).
Conclusions:
Our data suggest that morphine use may have no impact on long-term mortality and on predischarge ejection fraction in STEMI patients treated with primary PCI.
Insights
Intravenous morphine did not impact long-term mortality or ejection fraction in ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention. This study clarifies the safety of morphine use in STEMI patients on P2Y12 inhibitors.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Research
Background:
- Intravenous morphine (MO) may reduce the efficacy of oral P2Y12 inhibitors and potentially increase infarct size.
- Limited data exist on the clinical outcome impact of this drug interaction in ST-segment elevation myocardial infarction (STEMI) patients.
Purpose of the Study:
- To investigate the effect of intravenous morphine on mortality in STEMI patients treated with primary percutaneous coronary intervention (PCI).
- To assess the impact of morphine on left ventricular ejection fraction (LVEF) in this patient population.
Main Methods:
- A prospective registry study of 1255 STEMI patients undergoing primary PCI.
- 397 patients received intravenous morphine; clopidogrel was the P2Y12 inhibitor used.
- Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were employed to adjust for confounding factors.
Main Results:
- No significant difference in long-term all-cause mortality was observed between patients who received morphine and those who did not (HR 0.98, p=0.86 with PSM; HR 1.01, p=0.88 with IPTW).
- Predischarge left ventricular ejection fraction (LVEF) was similar in both groups, with median LVEFs of 50.0% in the morphine group and 50.0% in the no-morphine group, irrespective of the statistical method used.
Conclusions:
- Intravenous morphine administration appears to have no significant impact on long-term mortality in STEMI patients undergoing primary PCI.
- Morphine use did not adversely affect predischarge LVEF in this cohort, suggesting the drug interaction may not significantly alter clinical outcomes.
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