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

ATLANTIC Investigators

doi:10.1007/s40256-018-0305-0

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

ATLANTIC Investigators

Department of Cardiology

29 Citations (Scopus)

Abstract

BACKGROUND: 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.

METHODS: 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.

RESULTS: 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).

CONCLUSIONS: 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.

TRIAL REGISTRATION: clinicaltrials.gov identifier: NCT01347580.

Original language	English
Journal	American Journal of Cardiovascular Drugs
Volume	19
Issue number	2
Pages (from-to)	173-183
Number of pages	11
ISSN	1175-3277
DOIs	https://doi.org/10.1007/s40256-018-0305-0
Publication status	Published - Apr 2019

Keywords

Adult
Aged
Analgesics, Opioid/adverse effects
Female
Humans
Male
Middle Aged
Morphine/adverse effects
Pain/complications
Percutaneous Coronary Intervention
Platelet Aggregation Inhibitors/adverse effects
Platelet Glycoprotein GPIIb-IIIa Complex/antagonists & inhibitors
Retrospective Studies
ST Elevation Myocardial Infarction/complications
Ticagrelor/adverse effects
Treatment Outcome

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10.1007/s40256-018-0305-0

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@article{f2afbfd43103474d9e8f0c4939c05c88,

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

abstract = "BACKGROUND: 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.METHODS: 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.RESULTS: 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).CONCLUSIONS: 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.TRIAL REGISTRATION: clinicaltrials.gov identifier: NCT01347580.",

keywords = "Adult, Aged, Analgesics, Opioid/adverse effects, Female, Humans, Male, Middle Aged, Morphine/adverse effects, Pain/complications, Percutaneous Coronary Intervention, Platelet Aggregation Inhibitors/adverse effects, Platelet Glycoprotein GPIIb-IIIa Complex/antagonists \& inhibitors, Retrospective Studies, ST Elevation Myocardial Infarction/complications, Ticagrelor/adverse effects, Treatment Outcome",

author = "Fr{\'e}d{\'e}ric Lapostolle and \{Van't Hof\}, \{Arnoud W\} and Hamm, \{Christian W\} and Olivier Stibbe and Patrick Ecollan and Jean-Philippe Collet and Johanne Silvain and Lassen, \{Jens Flensted\} and Heutz, \{Wim M J M\} and Leonardo Bolognese and Cantor, \{Warren J\} and Angel Cequier and Mohamed Chettibi and Goodman, \{Shaun G\} and Hammett, \{Christopher J\} and Kurt Huber and Magnus Janzon and B{\'e}la Merkely and Storey, \{Robert F\} and \{Ten Berg\}, Jur and Uwe Zeymer and Muriel Licour and Anne Tsatsaris and Gilles Montalescot and \{ATLANTIC Investigators\}",

year = "2019",

month = apr,

doi = "10.1007/s40256-018-0305-0",

language = "English",

volume = "19",

pages = "173--183",

journal = "American Journal of Cardiovascular Drugs",

issn = "1175-3277",

publisher = "Adis",

number = "2",

}

TY - JOUR

T1 - Morphine and Ticagrelor Interaction in Primary Percutaneous Coronary Intervention in ST-Segment Elevation Myocardial Infarction

T2 - ATLANTIC-Morphine

AU - Lapostolle, Frédéric

AU - Van't Hof, Arnoud W

AU - Hamm, Christian W

AU - Stibbe, Olivier

AU - Ecollan, Patrick

AU - Collet, Jean-Philippe

AU - Silvain, Johanne

AU - Lassen, Jens Flensted

AU - Heutz, Wim M J M

AU - Bolognese, Leonardo

AU - Cantor, Warren J

AU - Cequier, Angel

AU - Chettibi, Mohamed

AU - Goodman, Shaun G

AU - Hammett, Christopher J

AU - Huber, Kurt

AU - Janzon, Magnus

AU - Merkely, Béla

AU - Storey, Robert F

AU - Ten Berg, Jur

AU - Zeymer, Uwe

AU - Licour, Muriel

AU - Tsatsaris, Anne

AU - Montalescot, Gilles

AU - ATLANTIC Investigators

PY - 2019/4

Y1 - 2019/4

N2 - BACKGROUND: 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.METHODS: 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.RESULTS: 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).CONCLUSIONS: 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.TRIAL REGISTRATION: clinicaltrials.gov identifier: NCT01347580.

AB - BACKGROUND: 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.METHODS: 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.RESULTS: 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).CONCLUSIONS: 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.TRIAL REGISTRATION: clinicaltrials.gov identifier: NCT01347580.

KW - Adult

KW - Aged

KW - Analgesics, Opioid/adverse effects

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Morphine/adverse effects

KW - Pain/complications

KW - Percutaneous Coronary Intervention

KW - Platelet Aggregation Inhibitors/adverse effects

KW - Platelet Glycoprotein GPIIb-IIIa Complex/antagonists & inhibitors

KW - Retrospective Studies

KW - ST Elevation Myocardial Infarction/complications

KW - Ticagrelor/adverse effects

KW - Treatment Outcome

UR - https://www.scopus.com/pages/publications/85055689783

U2 - 10.1007/s40256-018-0305-0

DO - 10.1007/s40256-018-0305-0

M3 - Journal article

C2 - 30353444

SN - 1175-3277

VL - 19

SP - 173

EP - 183

JO - American Journal of Cardiovascular Drugs

JF - American Journal of Cardiovascular Drugs

IS - 2

ER -

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

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Keywords

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