PMID- 32719075 OWN - NLM STAT- MEDLINE DCOM- 20201221 LR - 20240329 IS - 2053-3624 (Print) IS - 2053-3624 (Electronic) IS - 2053-3624 (Linking) VI - 7 IP - 2 DP - 2020 Jul TI - Prehospital opioid dose and myocardial injury in patients with ST elevation myocardial infarction. LID - 10.1136/openhrt-2020-001307 [doi] LID - e001307 AB - OBJECTIVE: To characterise the relationship between opioid dose and myocardial infarct size in patients with ST elevation myocardial infarction (STEMI). METHODS: Patients given opioid treatment by emergency medical services with confirmed STEMI were included in this secondary, retrospective cohort analysis of the Air versus Oxygen in Myocardial Infarction (AVOID) study. Patients with cardiogenic shock were excluded. The primary endpoint was comparison of cardiac biomarkers as a measure of infarct size based on opioid dose (low 15 mg of intravenous morphine equivalent dose). RESULTS: 422 patients were included in the analysis. There was a significantly higher proportion of patients with Thrombolysis in Myocardial Infarction (TIMI) 0 or 1 flow pre-percutaneous coronary intervention (PCI) (94% vs 81%, p=0.005) and greater use of thrombus aspiration catheters (59% vs 30%, p<0.001) in the high compared with low-dose opioid group. After adjustment for potential confounders, every 1 mg of intravenous morphine equivalent dose was associated with a 1.4% (95% CI 0.2%, 2.7%, p=0.028) increase in peak creatine kinase; however, this was no longer significant after adjustment for TIMI flow pre-PCI. CONCLUSIONS: Our study suggests no benefit of higher opioid dose and a dose-dependent signal between opioid dose and increased myocardial infarct size. Prospective randomised controlled trials are required to establish causality given that this may also be explained by patients with a greater ischaemic burden requiring higher opioid doses due to more severe pain. Future research also needs to focus on strategies to mitigate the opioid-P2Y12 inhibitor interaction and non-opioid analgesia to treat ischaemic chest pain. CI - (c) Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. FAU - Fernando, Himawan AU - Fernando H AUID- ORCID: 0000-0002-4775-6708 AD - Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia. AD - Central Clinical School, Monash University, Melbourne, Victoria, Australia. AD - Atherothrombosis and Vascular Biology, Baker Heart Research Institute, Melbourne, Victoria, Australia. FAU - Nehme, Ziad AU - Nehme Z AD - Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia. AD - Research & Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia. FAU - Peter, Karlheinz AU - Peter K AD - Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia. AD - Atherothrombosis and Vascular Biology, Baker Heart Research Institute, Melbourne, Victoria, Australia. FAU - Bernard, Stephen AU - Bernard S AD - Research & Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia. AD - Intensive Care Unit, Alfred Hospital, Melbourne, Victoria, Australia. FAU - Stephenson, Michael AU - Stephenson M AD - Research & Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia. FAU - Bray, Janet AU - Bray J AD - Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia. FAU - Cameron, Peter AU - Cameron P AD - Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia. FAU - Ellims, Andris AU - Ellims A AD - Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia. FAU - Taylor, Andrew AU - Taylor A AD - Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia. FAU - Kaye, David M AU - Kaye DM AD - Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia. AD - Heart Centre, Baker Heart Research Institute, Melbourne, Victoria, Australia. FAU - Smith, Karen AU - Smith K AD - Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia. AD - Research & Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia. FAU - Stub, Dion AU - Stub D AUID- ORCID: 0000-0001-8686-2709 AD - Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia d.stub@alfred.org.au. AD - Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia. AD - Heart Centre, Baker Heart Research Institute, Melbourne, Victoria, Australia. CN - AVOID investigators LA - eng PT - Journal Article PT - Multicenter Study PT - Observational Study PT - Research Support, Non-U.S. Gov't PL - England TA - Open Heart JT - Open heart JID - 101631219 RN - 0 (Analgesics, Opioid) RN - 0 (Biomarkers) RN - 0 (Troponin I) RN - EC 2.7.3.2 (Creatine Kinase) SB - IM MH - Aged MH - Analgesics, Opioid/*administration & dosage MH - Biomarkers/blood MH - Creatine Kinase/blood MH - *Emergency Medical Services MH - Female MH - Humans MH - Male MH - Middle Aged MH - Myocardium/metabolism/*pathology MH - *Percutaneous Coronary Intervention/adverse effects MH - Randomized Controlled Trials as Topic MH - Retrospective Studies MH - ST Elevation Myocardial Infarction/blood/pathology/*therapy MH - *Thrombectomy/adverse effects MH - Time Factors MH - Treatment Outcome MH - Troponin I/blood MH - Victoria PMC - PMC7380835 OTO - NOTNLM OT - STEMI OT - antiplatelet treatment OT - coronary intervention (PCI) OT - myocardial ischaemia and infarction (IHD) OT - platelet activation COIS- Competing interests: ZN is funded by a National Health and Medical Research Council Early Career Fellowship (#1146809). DS is funded by National Heart Foundation Fellowship and Viertel Foundation Grant. EDAT- 2020/07/29 06:00 MHDA- 2020/12/22 06:00 PMCR- 2020/07/22 CRDT- 2020/07/29 06:00 PHST- 2020/04/09 00:00 [received] PHST- 2020/05/18 00:00 [revised] PHST- 2020/05/27 00:00 [accepted] PHST- 2020/07/29 06:00 [entrez] PHST- 2020/07/29 06:00 [pubmed] PHST- 2020/12/22 06:00 [medline] PHST- 2020/07/22 00:00 [pmc-release] AID - openhrt-2020-001307 [pii] AID - 10.1136/openhrt-2020-001307 [doi] PST - ppublish SO - Open Heart. 2020 Jul;7(2):e001307. doi: 10.1136/openhrt-2020-001307.