title: Correlates of pre-hospital morphine use in ST-elevation myocardial infarction patients and its association with in-hospital outcomes and long-term mortality: the FAST-MI (French Registry of Acute ST-elevation and non-ST-elevation Myocardial Infarction) programme.
abstract: OBJECTIVE
  The use of opioids is recommended for pain relief in patients with myocardial infarction (MI) but may delay antiplatelet agent absorption, potentially leading to decreased treatment efficacy.
  
  
  RESULTS
  In-hospital complications (death, non-fatal re-MI, stroke, stent thrombosis, and bleeding) and 1-year survival according to pre-hospital morphine use were assessed in 2438 ST-elevation MI (STEMI) patients from the French Registry of Acute ST-elevation and non-ST-elevation Myocardial Infarction (FAST-MI) 2010. The analyses were replicated in the 1726 STEMI patients of the FAST-MI 2005 cohort, in which polymorphisms of CYP2C19 and ABCB1 had been assessed. Specific subgroup analyses taking into account these genetic polymorphisms were performed in patients pre-treated with thienopyridines. The 453 patients (19%) receiving morphine pre-hospital were younger, more often male, with a lower GRACE score and higher chest pain levels. After adjustment for baseline differences, in-hospital complications and 1-year survival (hazard ratio = 0.69; 95% confidence interval: 0.35-1.37) were not increased according to pre-hospital morphine use. After propensity score matching, 1-year survival according to pre-hospital morphine was also similar. Consistent results were found in the replication cohort, including in those receiving pre-hospital thienopyridines and whatever the genetic polymorphisms of CYP2C19 and ABCB1.
  
  
  CONCLUSIONS
  In two independent everyday-life cohorts, pre-hospital morphine use in STEMI patients was not associated with worse in-hospital complications and 1-year mortality.
  
  
  BACKGROUND
  Clinicaltrials.gov identifier: NCT00673036 (FAST-MI 2005); NCT01237418 (FAST-MI 2010).
authors.affiliation: Department of Cardiology, European Hospital of Georges Pompidou, Assistance Publique des Hôpitaux de Paris (AP-HP), 15-20 rue Leblanc, Paris 75015, France University Paris Descartes, Paris, France INSERM U-970, Paris, France etiennepuymirat@yahoo.fr etienne.puymirat@egp.aphp.fr.
authors.forename: Etienne
authors.initials: E
authors.lastname: Puymirat
authors.affiliation: D.A.R. and SAMU de Paris, Hôpital Necker, AP-HP, Paris Descartes University, Paris, France Inserm UMR-S970, Paris Cardiovascular Research Centre, Paris, France.
authors.forename: Lionel
authors.initials: L
authors.lastname: Lamhaut
authors.affiliation: Department of Cardiology, European Hospital of Georges Pompidou, Assistance Publique des Hôpitaux de Paris (AP-HP), 15-20 rue Leblanc, Paris 75015, France University Paris Descartes, Paris, France INSERM U-970, Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Bonnet
authors.affiliation: University Paris Descartes, Paris, France European Hospital of Georges Pompidou, Intensive Care unit AP-HP, Paris, France.
authors.forename: Nadia
authors.initials: N
authors.lastname: Aissaoui
authors.affiliation: Department of Cardiology, Hospital Lariboisière, AP-HP, Paris, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Henry
authors.affiliation: Department of Cardiology, University hospital Carémeau, Nîmes, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Cayla
authors.affiliation: Department of Cardiology, Intercity Hospital Le Raincy-Montfermeil, Montfermeil, France.
authors.forename: Simon
authors.initials: S
authors.lastname: Cattan
authors.affiliation: Department of Cardiology, Hôpital Bichat, AP-HP, Paris, France Sorbonne Paris-Cité, Université Paris-Diderot, Paris 75018, France INSERM U-698, Paris 75018, France.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Steg
authors.affiliation: Department of Cardiology, Clinique de Fontaine, Fontaine les Dijon, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Mock
authors.affiliation: Department of Cardiology, Hôpital Bichat, AP-HP, Paris, France Sorbonne Paris-Cité, Université Paris-Diderot, Paris 75018, France INSERM U-698, Paris 75018, France.
authors.forename: Gregory
authors.initials: G
authors.lastname: Ducrocq
authors.affiliation: Emergency Department, Lille Regional University Hospital, Lille, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Goldstein
authors.affiliation: Department of Cardiology, University Hospital Jean Minjoz, Besançon, France.
authors.forename: François
authors.initials: F
authors.lastname: Schiele
authors.affiliation: Department of Cardiology, Hôpital Cardiologique de Lyon, Lyon, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Bonnefoy-Cudraz
authors.affiliation: INSERM U-698, Paris 75018, France Clinical Research Unit (URC) - Est, AP-HP - Hospital Saint Antoine, Paris, France UPMC-Paris 06, Paris, France.
authors.forename: Tabassome
authors.initials: T
authors.lastname: Simon
authors.affiliation: Department of Cardiology, European Hospital of Georges Pompidou, Assistance Publique des Hôpitaux de Paris (AP-HP), 15-20 rue Leblanc, Paris 75015, France University Paris Descartes, Paris, France INSERM U-970, Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Danchin
mesh_terms: D018435:ATP Binding Cassette Transporter, Subfamily B / Q000235:genetics; D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D065731:Cytochrome P-450 CYP2C19 / Q000235:genetics; D004347:Drug Interactions / Q000235:genetics; D004632:Emergency Medical Services / Q000379:methods; D005260:Female; D005602:France / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use*; D000072658:Non-ST Elevated Myocardial Infarction / Q000188:drug therapy* / Q000235:genetics / Q000401:mortality; D010146:Pain / Q000517:prevention & control; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011110:Polymorphism, Genetic / Q000235:genetics; D012042:Registries; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000188:drug therapy* / Q000235:genetics / Q000401:mortality; D016896:Treatment Outcome
chemical_list: C513055:ABCB1 protein, human; D018435:ATP Binding Cassette Transporter, Subfamily B; D000701:Analgesics, Opioid; D010975:Platelet Aggregation Inhibitors; D009020:Morphine; D065731:Cytochrome P-450 CYP2C19
keywords: Acute myocardial infarction; Morphine; Opioids; ST-elevation myocardial infarction