Morphine and Cardiovascular Outcomes Among Patients With Non-ST-Segment Elevation Acute Coronary Syndromes Undergoing Coronary Angiography

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art_FURTADO_Morphine_and_Cardiovascular_Outcomes_Among_Patients_With_NonSTSegment_2020.PDF (827.87 KB)
Citações na Scopus
27
Tipo de produção
article
Data de publicação
2020
DOI
Scopus
Web of Science
PubMed
Título da Revista
ISSN da Revista
Título do Volume
Editora
ELSEVIER SCIENCE INC
Autores
GUO, Jianping
IM, Kyungah
WHITE, Jennifer A.
SABATINE, Marc S.
NEWBY, L. Kristin
GIUGLIANO, Robert P.
Citação
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, v.75, n.3, p.289-300, 2020
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
BACKGROUND Mechanistic studies have shown that morphine blunts the antiplatelet effects of oral adenosine diphosphate receptor blockers. However, the clinical relevance of this interaction is controversial. OBJECTIVES This study sought to explore the association between morphine and ischemic events in 5,438 patients treated with concomitant clopidogrel presenting with non-ST-segment elevation acute coronary syndromes (NSTEACS) in the EARLY ACS (Early Glycoprotein IIb/IIIa Inhibition in Patients With Non-ST-Segment Elevation Acute Coronary Syndrome) trial. Patients not treated with clopidogrel (n = 3,462) were used as negative controls. METHODS Endpoints were the composite of death, myocardial infarction (MI), recurrent ischemia, or thrombotic bailout at 96 h (4-way endpoint) and the composite of death or MI at 30 days. RESULTS In patients treated with clopidogrel, morphine use was associated with higher rates of the 4-way endpoint at 96 h (adjusted odds ratio [OR]: 1.40; 95% confidence interval [CI]: 1.04 to 1.87; p = 0.026). There was a trend for higher rates of death or MI at 30 days (adjusted OR: 1.29; 95% CI: 0.98 to 1.70; p = 0.072), driven by events in the first 48 h (adjusted hazard ratio: 1.54; 95% CI: 1.07 to 2.23; p = 0.021). In patients not treated with clopidogrel, morphine was not associated with either the 4-way endpoint at 96 h (adjusted OR: 1.05; 95% CI: 0.74 to 1.49; p = 0.79; p(interaction) = 0.36) or death or MI at 30 days (adjusted OR: 1.07; 95% CI: 0.77 to 1.48; p = 0.70; p(interaction) = 0.46). CONCLUSIONS When used concomitantly with clopidogrel pre-treatment, morphine was associated with higher rates of ischemic events in patients with NSTEACS. (C) 2020 by the American College of Cardiology Foundation.
Palavras-chave
ADP receptor blocker, clopidogrel, drug interaction, non-ST-segment elevation ACS, opioids
URI
https://observatorio.fm.usp.br/handle/OPI/35426
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Coleções
Artigos e Materiais de Revistas Científicas - FM/MCP
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