دورية أكاديمية
أعرض في EDS

Morphine and clinical outcomes in patients with ST segment elevation myocardial infarction treated with fibrinolytic and antiplatelet therapy: Insights from the TREAT trial.

التفاصيل البيبلوغرافية
العنوان: Morphine and clinical outcomes in patients with ST segment elevation myocardial infarction treated with fibrinolytic and antiplatelet therapy: Insights from the TREAT trial.
المؤلفون: Cantor WJ; Department of Medicine, Southlake Regional Health Centre, University of Toronto, 581 Davis Drive, Newmarket, Toronto, Ontario L3Y 2P6, Canada. Electronic address: cantorw@rogers.com., Tan M; Department of Medicine, Canadian Heart Research Centre, Toronto, Ontario, Canada., Berwanger O; Academic Research Organization (ARO), Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil., Lavi S; Department of Medicine, London Health Sciences Centre, Western University, London, Ontario, Canada., White HD; Department of Medicine, Cardiovascular Services, Auckland City Hospital, Auckland, New Zealand., Nicolau JC; Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil., Dehghani P; Department of Medicine, Prairie Vascular Research Network and Saskatchewan Health Authority, University of Saskatchewan, Regina, Saskatchewan, Canada., Tajer CD; Department of Medicine, Hospital de Alta Complejidad El Cruce, Buenos Aires, Argentina., Lopes RD; Department of Medicine, Duke Clinical Research Institute, Durham, NC, United States; Department of Medicine, Universidade Federal de São Paulo, São Paulo, Brazil., Moia DDF; Clinical Operations, Research Institute, Heart Hospital (HCor), São Paulo, Brazil., Nicholls SJ; Department of Medicine, Monash Cardiovascular Research Centre, Monash University, Melbourne, Victoria, Australia., Parkhomenko A; Department of Medicine, Emergency Cardiology Department, Institute of Cardiology, Kiev, Ukraine., Averkov O; Department of Medicine, Pirogov Russian National Research Medical University, Moscow, Russia., Brass N; Department of Medicine, CK Hui Heart Centre, Edmonton, Alberta, Canada., Lutchmedial S; Department of Medicine, New Brunswick Heart Centre, Dalhousie University, Halifax, Nova Scotia, Canada., Malaga G; Department of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru., Damiani LP; Clinical Operations, Research Institute, Heart Hospital (HCor), São Paulo, Brazil., Piegas LS; Department of Medicine, Heart Hospital (HCor), São Paulo, Brazil., Granger CB; Department of Medicine, Duke Clinical Research Institute, Durham, NC, United States., Goodman SG; Department of Medicine, Canadian Heart Research Centre (CHRC) and Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
المصدر: American heart journal [Am Heart J] 2022 Sep; Vol. 251, pp. 1-12. Date of Electronic Publication: 2022 May 06.
نوع المنشور: Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't
اللغة: English
بيانات الدورية: Publisher: Mosby Country of Publication: United States NLM ID: 0370465 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1097-6744 (Electronic) Linking ISSN: 00028703 NLM ISO Abbreviation: Am Heart J Subsets: MEDLINE
أسماء مطبوعة: Original Publication: St. Louis, MO : Mosby
مواضيع طبية MeSH: Percutaneous Coronary Intervention*/adverse effects , ST Elevation Myocardial Infarction*/therapy, Clopidogrel/therapeutic use ; Hemorrhage/chemically induced ; Humans ; Morphine/therapeutic use ; Platelet Aggregation Inhibitors/therapeutic use ; Thrombolytic Therapy ; Ticagrelor/therapeutic use ; Treatment Outcome
مستخلص: Background: Morphine is commonly used to relieve pain, anxiety and dyspnea in STEMI but it lowers blood pressure and delays the activity of oral antiplatelet agents. The impact of morphine on clinical outcomes remains unknown. This analysis was performed to determine if morphine use was associated with increased risk of adverse clinical events among STEMI patients treated with fibrinolytic therapy and clopidogrel or ticagrelor.
Methods: In the Ticagrelor in Patients with ST Elevation Myocardial Infarction Treated with Pharmacological Thrombolysis (TREAT) study, 3799 STEMI patients treated with fibrinolysis were randomized to receive clopidogrel or ticagrelor. Morphine use was left to the discretion of the treating physicians. In this pre-specified analysis, we evaluated clinical outcomes based on the use and timing of morphine administration. Outcomes were stratified by randomized treatment group. Multivariable analysis was performed using Inverse Probability Treatment Weighting (IPTW) weighting.
Results: Morphine was used in 53% of patients. After adjustment using IPTW weighting, morphine use was associated with higher hazard of reinfarction at 7 days (HR 4.9, P = .0006) and 30 days (HR 1.7, P = .04), and lower hazard of major bleeding (HR 0.37, P = .006). There was no significant difference in mortality at any time point.
Conclusions: Among patients with STEMI treated with fibrinolytic therapy, morphine use was associated with a higher risk of early reinfarction and a lower risk of major bleeding but no difference in mortality.
Clinical Trial Registration: clinicaltrials.gov Identifier: NCT02298088.
(Copyright © 2022 Elsevier Inc. All rights reserved.)
سلسلة جزيئية: ClinicalTrials.gov NCT02298088
المشرفين على المادة: 0 (Platelet Aggregation Inhibitors)
76I7G6D29C (Morphine)
A74586SNO7 (Clopidogrel)
GLH0314RVC (Ticagrelor)
تواريخ الأحداث: Date Created: 20220509 Date Completed: 20220706 Latest Revision: 20220830
رمز التحديث: 20231215
DOI: 10.1016/j.ahj.2022.05.005
PMID: 35533724
قاعدة البيانات: MEDLINE
الوصف
تدمد:1097-6744
DOI:10.1016/j.ahj.2022.05.005