University of Hertfordshire

  • Ying Gue
  • Nikolaos Spinthakis
  • Mohamed Farag
  • Jacek Kubica
  • Jolanta M Siller-Matula
  • Manivannan Srinivasan
  • Diana Gorog
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Original languageEnglish
JournalClinical Pharmacology & Therapeutics
Publication statusAccepted/In press - 6 Jan 2020


Opiates are the traditional analgesics used for pain relief in patients with ST-elevation myocardial infarction (STEMI). Pharmacodynamic studies indicate that opiates delay the absorption of orally-administered P2Y12 inhibitors and the onset of platelet inhibition. Whether the negative effect of opiates on platelet inhibition impacts 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 (PPCI). The primary endpoint was the occurrence of in-hospital recurrent myocardial infarction, and secondary endpoints included in-hospital stroke and death. Four observational studies, including a total of 3220 patients, were identified. Amongst patients with STEMI, those treated with morphine had a higher rate of re-infarction compared to 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). Mortality rate was lower in morphine-treated patients (1.7% 50 vs. 4.2%, OR 0.43, 95% CI 0.23-0.81; p=0.009). There was no difference in stroke according to morphine treatment. Patients undergoing PPCI who are pre-treated with morphine have a higher rate of reinfarction than patients not receiving morphine. This may be attributable to opiate-related delay in P2Y12 inhibitor absorption and resultant delay in onset of platelet inhibition. These concerning findings indicate the need for prospective, randomised trials to assess the impact of opiates on clinical outcomes in STEMI.

ID: 18690551