2019 · AMERICAN JOURNAL OF CARDIOVASCULAR DRUGS

Morphine and Ticagrelor Interaction in Primary Percutaneous Coronary Intervention in ST-Segment Elevation Myocardial Infarction: ATLANTIC-Morphine

Lapostolle, Frederic, van't Hof, Arnoud W., Hamm, Christian W., Stibbe, Olivier, Ecollan, Patrick, Collet, Jean-Philippe, Silvain, Johanne, Lassen, Jens Flensted, Heutz, Wim M. J. M., Bolognese, Leonardo, Cantor, Warren J., Cequier, Angel, Chettibi, Mohamed, Goodman, Shaun G., Hammett, Christopher J., Huber, Kurt, Janzon, Magnus, Merkely, Bela, Storey, Robert F., ten Berg, Jur, Zeymer, Uwe, Licour, Muriel, Tsatsaris, Anne, Montalescot, Gilles, Bougherbal, Rachid, Bouafia, Mohamed Tahar, Nibouche, Djamaleddine, Moklati, Abdelkader, Benalia, Ahmed, Krim, Messaad, Garraby, Paul, Jayasinghe, Rohan, Rashford, Stephen, Neunteufl, Thomas, Brussee, Helmut, Alber, Hannes, Weidinger, Franz, Baubin, Michael, Sebald, Dieter, Vijayaraghavan, Ram, Bata, Iqbal, Lavoie, Andrea, Ravkilde, Jan, Jensen, Lisette Okkels, Christensen, Alf Mol, Toftegaard, Marianne, Kohler, Dennis, Ducrocq, Gregory, Danchin, Nicolas, Henry, Patrick, Livarek, Bernard, Berthier, Romain, Hovasse, Thomas, Garot, Philippe, Payot, Laurent, Benamer, Hakim, Esteve, Jean Baptiste, Elhadad, Simon, Teiger, Emmanuel, Bonnet, Jean Louis, Paganelli, Franck, Cottin, Yves, Schiele, Francois, Thuaire, Christophe, Cayla, Guillaume, Coste, Pierre, Ohlmann, Patrick, Cudraz, Eric Bonnefoy, Lantelme, Pierre, Perret, Thibault, Tron, Christophe, De labriolle, Axel, Aptecar, Edouardo, Beliard, Olivier, Varenne, Olivier, El Mahmoud, Rami, Filippi-Codaccioni, Emmanuelle, Angoulvant, Denis, Peycher, Patrick, Poitrineau, Olivier, Tabone, Xavier, Broche, Claire, Lambert, Yves, Briole, Nicolas, Beruben, Arielle, Porcher, Nicolas, Auffray, Jean-Pierre, Freysz, Marc, Depardieu, Franck, Poubel, David, De La Cousaye, Jean-Emmanuel, Bartier, Jean-Claude, Jardel, Benoit, Boulanger, Bertrand, Labourel, Herve, Soulat, Louis-Christophe, Julie, Veronique, Thicoipe, Michel, Capel, Olivier, Carli, Pierre, Tazarourte, Karim, Alcouffe, Fabrice, Aboucaya, David, Aubert, Gaele, Kierzek, Gerald, Cahun-Giraud, Severine, Dengler, Thomas, Prondzinsky, Roland, Biever, Paul Marc, Schafer, Andreas, Seyfarth, Melchior, Lemke, Bernd, Werner, Gerald, Nef, Holger, Steiger, Holger, Leschke, Matthias, Munzel, Thomas, Orto, Marco Campo Dell, Loges, Christian, Schinke, Monika, Koberne, Frank, Reiffen, Hans Peter, Tiroch, Klaus, Wierich, Dirk, Kneussel, Michael, Little, Simon, Sauer, Hartmut, Laufenberg-Feldmann, Rita, Ungi, Imre, Horvath, Ivan, Edes, Istvan, Martai, Istvan, Berti, Sergio, Chiarella, Francesco, Calabria, Paolo, Fineschi, Massimo, Galvani, Marcello, Valgimigli, Marco, Moretti, Luciano, Tespili, Maurizio, Mando, Massimo, Bermano, Francesco, Biagioni, Robusto, Fabbri, Andrea, Ricciardelli, Adelina, Petroni, Maria Romana, Vatteroni, Umberto Roberto, Palumbo, Francesco, Willems, Frank F., Al Mafragi, Amar, Heestermans, Ton A. A. C. M., Van Eck, Martijn J., Meppelder, H. H., Jong, Anika Roukema-de, Van de Pas, Harm, Fillat, Angel Cequier, Sabate Tenas, Manel, Mauri Ferrer, Josepa, Serra Penaranda, Antoni, Angel Ferrer, Joan, Garcia Del Blanco, Bruno, Miranda Guardiola, Faustino, Ruiz Nodar, Juan Miguel, Iniguez Romo, Andres, Vazquez Gonzalez, Nicolas, Trillo Nouche, Ramiro, Diaz De La Llera, Luis, Hernandez Garcia, Jose Maria, Rivero-Crespo, Fernando, Hernandez Hernandez, Felipe, Luis Zamorano, Jose, Jimenez Farega, Xavier, Alonso Fernandez, Gilberto, Luis Toboso, Jose, Carrasco, Mercedes, Barreiro, Victoria, Iglesias Vazquez, Jose Antonio, Ruiz Montero, Maria del Mar, Rosell Ortiz, Fernando, Garcia Escudero, Guillermo, Sanchez-Brunete Ingelmo, Vicente, Lara Garcia, Antonio, Oldgren, Jonas, Calais, Fredrik, Kastberg, Robert, Bergsten, Per-Adolf, Blomberg, Hans, Thorn, Kristian, Skoog, Gunnar, Zaman, Azfar, Gerber, Robert, Ryding, Alisdair, Spence, Mark, Swanson, Neil, Been, Martin, Grosser, Konrad, Schofield, Peter, Mackin, David, Fell, Paul, Quinn, Tom, Foster, Teresa, McManus, David, Carson, Andy, ATLANTIC Investigators

Journal
AMERICAN JOURNAL OF CARDIOVASCULAR DRUGS
Année
2019
Volume
19
Numéro
2
Pages
173-183
Mois
APR
DOI
10.1007/s40256-018-0305-0

Abstract

BackgroundMorphine 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.MethodsATLANTIC was an international, multicenter, randomized study of treatment in the acute ambulance/hospital setting where STEMI patients received ticagrelor 180mgmorphine. Patient characteristics, cardiovascular history, risk factors, management, and outcomes were recorded.ResultsOpioids (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-PCI70% 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).ConclusionsMorphine-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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