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dc.contributor.authorGue, Ying
dc.contributor.authorSpinthakis, Nikolaos
dc.contributor.authorFarag, Mohamed
dc.contributor.authorKubica, Jacek
dc.contributor.authorSiller-Matula, Jolanta M
dc.contributor.authorSrinivasan, Manivannan
dc.contributor.authorGorog, Diana
dc.date.accessioned2020-02-08T01:09:44Z
dc.date.available2020-02-08T01:09:44Z
dc.date.issued2020-01-28
dc.identifier.citationGue , Y , Spinthakis , N , Farag , M , Kubica , J , Siller-Matula , J M , Srinivasan , M & Gorog , D 2020 , ' Impact of Preadmission Morphine on Reinfarction in Patients With ST-Elevation Myocardial Infarction Treated With Percutaneous Coronary Intervention : A Meta-Analysis ' , Clinical Pharmacology & Therapeutics . https://doi.org/10.1002/cpt.1798
dc.identifier.issn1532-6535
dc.identifier.otherPURE: 18690551
dc.identifier.otherPURE UUID: 4b8964d0-5d53-48fc-afae-71d76eab41cc
dc.identifier.otherScopus: 85080078706
dc.identifier.urihttp://hdl.handle.net/2299/22169
dc.description© 2020 American Society for Clinical Pharmacology and Therapeutics. This is the peer reviewed version of the following article: Impact of pre-admission morphine on re-infarction 1 in patients with STEMI 2 treated with PPCI: a meta-analysis, which has been published in final form at https://doi.org/10.1002/cpt.1798 purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.
dc.description.abstractOpiates are the traditional analgesics used in patients with ST-elevation myocardial infarction (STEMI). Pharmacodynamic studies indicate that opiates delay the absorption of orally administered P2Y 12 inhibitors and the onset of platelet inhibition. Whether these negative effects on platelet inhibition have an impact on clinical outcomes is unclear. A systematic review and meta-analysis was performed searching PubMed, MEDLINE, and Cochrane Central Register of Controlled Trials to identify studies comparing morphine and no-morphine treatment in STEMI patients undergoing primary percutaneous coronary intervention. The primary end point was the occurrence of in-hospital myocardial infarction, and secondary end points were in-hospital stroke and death. Four observational studies were identified, including 3,220 patients with STEMI. Morphine-treated patients had a higher unadjusted rate of reinfarction compared with patients not receiving morphine (1.5% vs. 0.67%, odds ratio (OR) 2.41; 95% confidence interval (CI), 1.11–5.21; P = 0.03). Unadjusted mortality rate was lower in morphine-treated patients (1.7% vs. 4.2%, OR 0.43, 95% CI, 0.23–0.81; P = 0.009). Exclusion of the study with baseline differences between groups showed more frequent reinfarction in the morphine group, but this was no longer statistically significant (1.3% vs. 0.5%, OR 2.02; 95% CI, 0.39–10.43; P = 0.40). There was no difference in stroke according to morphine treatment. Patients pretreated with morphine appear to have a higher rate of reinfarction than patients not receiving morphine. This may be attributable to opiate-related delay in P2Y 12 inhibitor absorption and resultant delay in onset of platelet inhibition. These concerning findings indicate the need for prospective, randomized trials to assess the impact of opiates on clinical outcomes in STEMI.en
dc.language.isoeng
dc.relation.ispartofClinical Pharmacology & Therapeutics
dc.rightsEmbargoed
dc.subjectPharmacology
dc.subjectPharmacology (medical)
dc.titleImpact of Preadmission Morphine on Reinfarction in Patients With ST-Elevation Myocardial Infarction Treated With Percutaneous Coronary Intervention : A Meta-Analysisen
dc.contributor.institutionDepartment of Clinical and Pharmaceutical Sciences
dc.contributor.institutionCentre for Health Services and Clinical Research
dc.contributor.institutionBasic and Clinical Science Unit
dc.contributor.institutionSchool of Life and Medical Sciences
dc.contributor.institutionDepartment of Clinical, Pharmaceutical and Biological Science
dc.description.statusPeer reviewed
dc.date.embargoedUntil2021-01-28
dc.identifier.urlhttp://www.scopus.com/inward/record.url?scp=85080078706&partnerID=8YFLogxK
dc.relation.schoolSchool of Life and Medical Sciences
dc.description.versiontypeFinal Accepted Version
dcterms.dateAccepted2020-01-28
rioxxterms.versionAM
rioxxterms.versionAM
rioxxterms.versionofrecordhttps://doi.org/10.1002/cpt.1798
rioxxterms.licenseref.uriOther
rioxxterms.typeJournal Article/Review
herts.preservation.rarelyaccessedtrue
herts.rights.accesstypeEmbargoed


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