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

Morphine 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...

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Bibliográfiai részletek
Szerzők: Lapostolle Frédéric
Hof, Van't 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
Merkely Béla Péter
ATLANTIC Investigators
Ungi Imre
Dokumentumtípus: Cikk
Megjelent: 2019
Sorozat:AMERICAN JOURNAL OF CARDIOVASCULAR DRUGS 19 No. 2
doi:10.1007/s40256-018-0305-0

mtmt:30611094
Online Access:http://publicatio.bibl.u-szeged.hu/18131
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520 3 |a Morphine 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.ATLANTIC was an international, multicenter, randomized study of treatment in the acute ambulance/hospital setting where STEMI patients received ticagrelor 180 mg ± morphine. Patient characteristics, cardiovascular history, risk factors, management, and outcomes were recorded.Opioids (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-PCI ≥ 70% 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).Morphine-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.clinicaltrials.gov identifier: NCT01347580. 
700 0 2 |a Hof, Van't Arnoud W.  |e aut 
700 0 2 |a Hamm Christian W  |e aut 
700 0 2 |a Stibbe Olivier  |e aut 
700 0 2 |a Ecollan Patrick  |e aut 
700 0 2 |a Collet Jean‑Philippe  |e aut 
700 0 2 |a Silvain Johanne  |e aut 
700 0 2 |a Lassen Jens Flensted  |e aut 
700 0 2 |a Heutz Wim M. J. M.  |e aut 
700 0 2 |a Bolognese Leonardo  |e aut 
700 0 2 |a Cantor Warren J.  |e aut 
700 0 2 |a Cequier Angel  |e aut 
700 0 2 |a Merkely Béla Péter  |e aut 
700 0 2 |a ATLANTIC Investigators  |e aut 
700 0 2 |a Ungi Imre  |e aut 
856 4 0 |u http://publicatio.bibl.u-szeged.hu/18131/1/2019_MorphineAndTicagrelorInteracti_AJCD.pdf  |z Dokumentum-elérés