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Intravenous morphine administration and reperfusion success in ST-elevation myocardial infarction: insights from cardiac magnetic resonance imaging

Clinical Research in Cardiology volume 104, pages 727–734 (2015)Cite this article

Abstract

Aims

Intravenous (IV) morphine has been shown to be independently associated with adverse clinical outcome in patients with non-STEMI. Currently, there are no data on the association of IV morphine and reperfusion success in STEMI. Thus, we thought to analyse the impact of IV morphine on ischemic injury and salvaged myocardium assessed by cardiac magnetic resonance imaging (CMR) in patients with STEMI reperfused by primary coronary intervention (PCI).

Methods and results

STEMI patients reperfused by primary PCI (n = 276) within 12 h after symptom onset underwent CMR 3 days after the index event [interquartile range (IQR) 2–4]. IV morphine administration was recorded in all patients. IV morphine was administered in 44.7 % (n = 123) of all patients. Patients in the IV morphine group displayed larger infarct size, higher extent of MO and lower myocardial salvage index (MSI) in comparison to the non-IV morphine group (all p < 0.05). In multivariable logistic regression analysis adjusted for TIMI-flow pre-PCI, time from symptom onset to PCI, Killip class and left ventricular ejection fraction, IV morphine was identified as an independent predictor for MSI <median (odds ratio 1.71, 95 % CI 1.02–2.87, p = 0.04).

Conclusion

In patients with STEMI, IV morphine administration prior to PCI is independently associated with suboptimal reperfusion success. These findings warrant randomised clinical trials assessing the effect of IV morphine on clinical outcome.

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Acknowledgments

We gratefully acknowledge our colleagues from the Department of Diagnostic and Interventional Radiology at the University Leipzig, Heart Centre supporting CMR image acquisition.

Conflict of interest

On behalf of all the authors, the corresponding author states that there is no conflict of interest.

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Affiliations

  1. University Heart Centre, Medical Clinic II, Department of Cardiology/Angiology/Intensive Care Medicine, University of Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany

    Suzanne de Waha, Ingo Eitel, Steffen Desch & Holger Thiele

  2. Heart Centre, Department of Internal Medicine/Cardiology, University of Leipzig, Strümpellstr 39, 04289 , Leipzig, Germany

    Georg Fuernau, Philipp Lurz, Daniel Urban & Gerhard Schuler

Authors
  1. Suzanne de Waha
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  2. Ingo Eitel
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  3. Steffen Desch
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  4. Georg Fuernau
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  5. Philipp Lurz
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  6. Daniel Urban
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  7. Gerhard Schuler
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  8. Holger Thiele
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Correspondence to Suzanne de Waha.

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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 104, 727–734 (2015). https://doi.org/10.1007/s00392-015-0835-2

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  • DOI: https://doi.org/10.1007/s00392-015-0835-2

Keywords

  • Morphine
  • ST-elevation myocardial infarction
  • Reperfusion success
  • Cardiac magnetic resonance imaging