PMID- 29166703
OWN - NLM
STAT- MEDLINE
DCOM- 20180827
LR  - 20240314
IS  - 1540-8183 (Electronic)
IS  - 0896-4327 (Print)
IS  - 0896-4327 (Linking)
VI  - 31
IP  - 2
DP  - 2018 Apr
TI  - In-hospital outcomes in invasively managed acute myocardial infarction patients 
      who receive morphine.
PG  - 150-158
LID - 10.1111/joic.12464 [doi]
AB  - OBJECTIVE: We aimed to analyze the association between morphine and in-hospital 
      outcomes in invasively managed ST elevation myocardial infarction (STEMI) and 
      non-ST elevation acute coronary syndrome (NSTE-ACS) patients. BACKGROUND: 
      Morphine is commonly used for analgesia in the setting of acute coronary 
      syndromes (ACS); however, recently its utility in ACS has come under closer 
      scrutiny. METHODS: We identified all STEMI and NSTE-ACS patients undergoing 
      coronary angiogram +/- percutaneous intervention between January 2009 and July 
      2016 in our center and recorded patient characteristics and inpatient outcomes. 
      RESULTS: Overall, 3027 patients were examined. Overall, STEMI patients who 
      received morphine had no difference in in-hospital mortality [4.18% vs. 7.54%, 
      odds ratio (OR): 0.36, P = 0.19], infarct size (mean troponin level 0.75 ng/mL 
      vs. 1.29 ng/mL, P = 0.32) or length of hospital stay (P = 0.61). The NSTE-ACS 
      patients who received morphine had a longer hospital stay (mean 6.58 days vs. 
      4.78 days, P < 0.0001) and larger infarct size (mean troponin 1.16 ng/mL vs. 
      0.90 ng/mL, P = 0.02). Comparing matched patients, the use of morphine was 
      associated with larger infarct size (mean troponin 1.14 +/- 1.92 ng/mL vs. 
      0.83 +/- 1.49 ng/mL, P = 0.01), longer hospital stay (6.5 +/- 6.82 days vs. 
      4.89 +/- 5.36 days, P = 0.004) and a trend towards increased mortality (5% vs. 2%, 
      OR: 2.55, P = 0.06) in NSTE-ACS patients but morphine did not affect outcomes in 
      the propensity matched STEMI patients. CONCLUSION: In a large retrospective 
      study, morphine was associated with larger infarct size, a longer hospital stay 
      and a trend towards increased mortality in invasively managed NSTE-ACS patients 
      even after adjustment for clinical characteristics.
CI  - (c) 2017, Wiley Periodicals, Inc.
FAU - McCarthy, Cian P
AU  - McCarthy CP
AUID- ORCID: 0000-0003-4944-0034
AD  - Department of Medicine, Massachusetts General Hospital, Boston, MA.
FAU - Bhambhani, Vijeta
AU  - Bhambhani V
AD  - Division of Cardiology, Department of Medicine, Massachusetts General Hospital, 
      Boston, MA.
FAU - Pomerantsev, Eugene
AU  - Pomerantsev E
AD  - Division of Cardiology, Department of Medicine, Massachusetts General Hospital, 
      Boston, MA.
FAU - Wasfy, Jason H
AU  - Wasfy JH
AD  - Division of Cardiology, Department of Medicine, Massachusetts General Hospital, 
      Boston, MA.
LA  - eng
GR  - KL2 TR001100/TR/NCATS NIH HHS/United States
GR  - UL1 TR001102/TR/NCATS NIH HHS/United States
PT  - Journal Article
DEP - 20171122
PL  - United States
TA  - J Interv Cardiol
JT  - Journal of interventional cardiology
JID - 8907826
RN  - 0 (Analgesics, Opioid)
RN  - 76I7G6D29C (Morphine)
SB  - IM
MH  - *Acute Coronary Syndrome/diagnosis/drug therapy/mortality/surgery
MH  - Aged
MH  - Analgesics, Opioid/administration & dosage/adverse effects
MH  - Female
MH  - Hospital Mortality
MH  - Humans
MH  - Length of Stay
MH  - Male
MH  - Middle Aged
MH  - *Morphine/administration & dosage/adverse effects
MH  - Odds Ratio
MH  - Outcome and Process Assessment, Health Care
MH  - *Percutaneous Coronary Intervention/adverse effects/methods
MH  - Retrospective Studies
MH  - *ST Elevation Myocardial Infarction/diagnosis/drug therapy/mortality/surgery
MH  - United States/epidemiology
PMC - PMC5897161
MID - NIHMS918036
OTO - NOTNLM
OT  - NTE-ACS
OT  - STEMI
OT  - morphine
EDAT- 2017/11/23 06:00
MHDA- 2018/08/28 06:00
PMCR- 2019/04/01
CRDT- 2017/11/23 06:00
PHST- 2017/06/12 00:00 [received]
PHST- 2017/10/13 00:00 [revised]
PHST- 2017/10/17 00:00 [accepted]
PHST- 2017/11/23 06:00 [pubmed]
PHST- 2018/08/28 06:00 [medline]
PHST- 2017/11/23 06:00 [entrez]
PHST- 2019/04/01 00:00 [pmc-release]
AID - 10.1111/joic.12464 [doi]
PST - ppublish
SO  - J Interv Cardiol. 2018 Apr;31(2):150-158. doi: 10.1111/joic.12464. Epub 2017 Nov 
      22.