Related Links
Statistics
| Number of Journals | 8 |
| Number of Issues | 59 |
| Number of Articles | 435 |
| Article View | 155,257 |
| PDF Download | 102,530 |
The impact of using morphine or meperidine on clinical outcomes of ST-elevation myocardial infarction patients undergoing primary percutaneous intervention | ||
| Cardiovascular Biomedicine | ||
| Volume 5, Issue 2, December 2025, Pages 51-58 PDF (356.58 K) | ||
| Document Type: original articles | ||
| DOI: 10.18502/cbj.v5i2.21136 | ||
| Authors | ||
| Farzaneh Hashemzadeh1; Amirhosein Ghafouri-Asbagh1; Amirreza Khalaji2; Negar Jafari1; Ahmad Separham* 1 | ||
| 1Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran | ||
| 2Immunology Research Center, Tabriz University of medical sciences, Tabriz, Iran | ||
| Abstract | ||
| Objectives: Opioids are commonly used for treating chest pain in patients with acute coronary syndrome. Despite the beneficial effects of opioids, they could have adverse effects on patients, too. This study aims to compare the effects of morphine and meperidine on major adverse cardiac events (MACE) and mortality in patients undergoing percutaneous intervention. Methods: The researchers retrospectively reviewed data from 161 patients with the confirmed diagnosis of ST-elevation myocardial infarction undergoing primary percutaneous intervention. We compared the medical records of patients with MACE. In-hospital and one-year MACE were our primary measured outcomes. Results: Patients treated with morphine were more likely to experience in-hospital MACE (P-value: 0.006). Heart failure in the hospital was more in the morphine group (p-value: 0.002). However, none of the one-year clinical outcomes were statistically different between the two groups treated with morphine or meperidine. Left ventricular ejection fraction, ischemic heart disease, and hospital length of stay remained independent variables for predicting both in-hospital and one-year MACE, but morphine or meperidine didn’t remain independent in multivariable analysis. Conclusions: Although heart failure occurred more frequently in patients who received morphine, neither morphine nor meperidine independently predicted in-hospital or one-year MACE. | ||
| Keywords | ||
| ST-elevation MI; Percutaneous intervention; Morphine; Meperidine | ||
| References | ||
|
1. Thygesen K, Alpert JS, Jaffe AS, et al. Fourth Universal Definition of Myocardial Infarction (2018). Circulation. 2018;138(20):e618-e651.
2. Benjamin EJ, Muntner P, Alonso A, et al. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation. 2019;139(10):e56-e528.
3. Thomas MP, Bates ER. Update on primary PCI for patients with STEMI. Trends Cardiovasc Med. 2017;27(2):95-102.
4. Herlitz J, Hjalmarson A, Waagstein F. Treatment of pain in acute myocardial infarction. Br Heart J. 1989;61(1):9-13.
5. Tavenier AH, Hermanides RS, Ottervanger JP, et al. Risks of Opioids in ST-Elevation Myocardial Infarction: A Review. Drug Saf. 2018;41(12):1303-1308.
6. Anderson JL, Adams CD, Antman EM, et al. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-Elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine. J Am Coll Cardiol. 2007;50(7):e1-e157.
7. Nielsen JR, Pedersen KE, Dahlstrøm CG, et al. Analgetic treatment in acute myocardial infarction. A controlled clinical comparison of morphine, nicomorphine and pethidine. Acta Med Scand. 1984;215(4):349-54.
8. Yan W, Yang S, Chen L, et al. Analgesia in acute ischemic chest pain. Coron Artery Dis. 2020;31(6):556-564.
9. Kubica J, Adamski P, Ostrowska M, et al. Morphine delays and attenuates ticagrelor exposure and action in patients with myocardial infarction: the randomized, double-blind, placebo-controlled IMPRESSION trial. Eur Heart J. 2016;37(3):245-52.
10. Holzer P. Opioid receptors in the gastrointestinal tract. Regul Pept. 2009;155(1-3):11-7.
11. Heestermans AA, van Werkum JW, Taubert D, et al. Impaired bioavailability of clopidogrel in patients with a ST-segment elevation myocardial infarction. Thromb Res. 2008;122(6):776-81.
12. Parodi G, Bellandi B, Xanthopoulou I, et al. Morphine is associated with a delayed activity of oral antiplatelet agents in patients with ST-elevation acute myocardial infarction undergoing primary percutaneous coronary intervention. Circ Cardiovasc Interv.2014;8(1):e001593.
13. Markiewicz W, Finberg JP, Lichtig C. Morphine increases myocardial infarction size in rats. Anesth Analg. 1982;61(10):843-6.
14. Schultz JE, Gross GJ. Opioids and cardioprotection. Pharmacol Ther. 2001;89(2):123-37.
15. Bellandi B, Zocchi C, Xanthopoulou I, et al. Morphine use and myocardial reperfusion in patients with acute myocardial infarction treated with primary PCI. Int J Cardiol. 2016;221:567-71.
16. De Waha S, Eitel I, Desch S, et al. Intravenous morphine administration and reperfusion success in ST-elevation myocardial infarction: insights from cardiac magnetic resonance imaging. Clin Res Cardiol. 2015;104(9):727-34.
17. Fernando H, Nehme Z, Peter K, et al. Prehospital opioid dose and myocardial injury in patients with ST elevation myocardial infarction. Open Heart. 2020;7(2):e001307.
18. McCarthy CP, Bhambhani V, Pomerantsev E, et al. In-hospital outcomes in invasively managed acute myocardial infarction patients who receive morphine. J Interv Cardiol. 2018;31(2):150-158.
19. Bonin M, Mewton N, Roubille F, et al. Effect and Safety of Morphine Use in Acute Anterior ST-Segment Elevation Myocardial Infarction. J Am Heart Assoc. 2018;7(4):e006833.
20. Eitel I, Wang J, Stiermaier T, et al. Impact of Morphine Treatment on Infarct Size and Reperfusion Injury in Acute Reperfused ST-Elevation Myocardial Infarction. J Clin Med. 2020;9(3):735.
21. Clark RF, Wei EM, Anderson PO. Meperidine: therapeutic use and toxicity. J Emerg Med. 1995;13(6): 797-802.
22. Eisendrath SJ, Goldman B, Douglas J, et al. Meperidine-induced delirium. Am J Psychiatry. 1987;144(8):1062-5.
23. Lee G, DeMaria AN, Amsterdam EA, et al. Comparative effects of morphine, meperidine and pentazocine on cardiocirculatory dynamics in patients with acute myocardial infarction. Am J Med. 1976;60 (7):949-55. | ||
|
Statistics Article View: 13 PDF Download: 8 |
||