Morphine and P2Y12 Inhibitors in ST-Elevation Myocardial Infarction: An Updated Meta-Analysis.

IF 2.8 4区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Ryan Berry, Khaled M Harmouch, Alaa Roto, Nomesh Kumar, Zohaib Khan, Resha Khanal, Mohammad Hamza, Yasemin Bahar, Yasar Sattar, Wael Aljaroudi, Timir K Paul, M Chadi Alraies
{"title":"Morphine and P2Y12 Inhibitors in ST-Elevation Myocardial Infarction: An Updated Meta-Analysis.","authors":"Ryan Berry, Khaled M Harmouch, Alaa Roto, Nomesh Kumar, Zohaib Khan, Resha Khanal, Mohammad Hamza, Yasemin Bahar, Yasar Sattar, Wael Aljaroudi, Timir K Paul, M Chadi Alraies","doi":"10.1007/s40256-024-00708-7","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Morphine is used to control pain in ST-elevation myocardial infarction but reduces P2Y12 inhibition. It is not known if this modulation of platelet inhibition appreciably affects clinical outcomes.</p><p><strong>Methods: </strong>We screened 979 articles and identified seven studies that met the eligibility criteria for meta-analysis. Outcomes included 11 metrics across angiographic and clinical domains. A random effects model assessed heterogeneity between studies.</p><p><strong>Results: </strong>The opiate group showed decreased achievement of postprocedural thrombolysis in myocardial infarction (TIMI) 2 flow relative to placebo [risk ratio (RR) 0.71, 95% confidence interval (CI) 0.52-0.97, p = 0.03, I<sup>2</sup> = 0.0%]. All other metrics listed below showed no statistically significant difference between groups: infarct size, microvascular obstruction, microvascular/salvage index, absence of pre- percutaneous coronary intervention (PCI) TIMI 3 flow, postprocedural TIMI 2 flow, postprocedural TIMI 3 flow, all-cause mortality, stroke, repeat MI, unstable angina, and left ventricular ejection fraction. However, there were no statistically significant differences in infarct size [odds ratio (OR) - 0.12, 95% CI - 0.37 to 0.17, p = 0.42], microvascular obstruction [standard mean difference (SMD) = 0.02, 95% CI - 0.12 to 0.16, p = 0.82], microvascular obstruction/salvage index (SMD = - 0.05, 95% CI - 0.24 to 0.13, p = 0.57), absence of pre-PCI TIMI 3 flow (OR 0.98, 95% CI 0.79-1.22, p = 0.87), and postprocedural TIMI 3 flow (OR 1.23, 95% CI 0.84-1.79, p = 0.28) between the two groups.</p><p><strong>Conclusions: </strong>In STEMI, opiates correlate with worse angiographic outcomes, specifically postprocedural TIMI 2 flow. However, this observation does not appear to be clinically consequential.</p>","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":" ","pages":""},"PeriodicalIF":2.8000,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"American Journal of Cardiovascular Drugs","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s40256-024-00708-7","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0

Abstract

Background: Morphine is used to control pain in ST-elevation myocardial infarction but reduces P2Y12 inhibition. It is not known if this modulation of platelet inhibition appreciably affects clinical outcomes.

Methods: We screened 979 articles and identified seven studies that met the eligibility criteria for meta-analysis. Outcomes included 11 metrics across angiographic and clinical domains. A random effects model assessed heterogeneity between studies.

Results: The opiate group showed decreased achievement of postprocedural thrombolysis in myocardial infarction (TIMI) 2 flow relative to placebo [risk ratio (RR) 0.71, 95% confidence interval (CI) 0.52-0.97, p = 0.03, I2 = 0.0%]. All other metrics listed below showed no statistically significant difference between groups: infarct size, microvascular obstruction, microvascular/salvage index, absence of pre- percutaneous coronary intervention (PCI) TIMI 3 flow, postprocedural TIMI 2 flow, postprocedural TIMI 3 flow, all-cause mortality, stroke, repeat MI, unstable angina, and left ventricular ejection fraction. However, there were no statistically significant differences in infarct size [odds ratio (OR) - 0.12, 95% CI - 0.37 to 0.17, p = 0.42], microvascular obstruction [standard mean difference (SMD) = 0.02, 95% CI - 0.12 to 0.16, p = 0.82], microvascular obstruction/salvage index (SMD = - 0.05, 95% CI - 0.24 to 0.13, p = 0.57), absence of pre-PCI TIMI 3 flow (OR 0.98, 95% CI 0.79-1.22, p = 0.87), and postprocedural TIMI 3 flow (OR 1.23, 95% CI 0.84-1.79, p = 0.28) between the two groups.

Conclusions: In STEMI, opiates correlate with worse angiographic outcomes, specifically postprocedural TIMI 2 flow. However, this observation does not appear to be clinically consequential.

ST段抬高型心肌梗死中的吗啡和 P2Y12 抑制剂:最新的 Meta 分析。
背景:吗啡用于控制st段抬高型心肌梗死的疼痛,但可降低P2Y12抑制。目前尚不清楚这种对血小板抑制的调节是否会明显影响临床结果。方法:我们筛选了979篇文章,并确定了7项符合meta分析资格标准的研究。结果包括横跨血管造影和临床领域的11个指标。随机效应模型评估研究之间的异质性。结果:与安慰剂相比,阿片类药物组术后心肌梗死(TIMI) 2血流溶栓成功率降低[危险比(RR) 0.71, 95%可信区间(CI) 0.52 ~ 0.97, p = 0.03, I2 = 0.0%]。以下列出的所有其他指标在两组之间没有统计学差异:梗死面积、微血管阻塞、微血管/挽救指数、无经皮冠状动脉介入治疗(PCI) timi3血流、术后timi2血流、术后timi3血流、全因死亡率、卒中、重复心肌梗死、不稳定型心绞痛和左心室射血分数。然而,没有统计上显著的差异在梗塞大小(比值比(或)- 0.12,95%置信区间,0.37至0.17,p = 0.42),微血管阻塞(标准平均差(SMD) = 0.02, 95% CI, 0.12 - 0.16, p = 0.82),微血管阻塞/救助指数(SMD = - 0.05, 95%置信区间,0.24至0.13,p = 0.57),缺乏pre-PCI TIMI 3流(或0.98,95%可信区间0.79 - -1.22,p = 0.87),和postprocedural TIMI 3流(或1.23,95%可信区间0.84 - -1.79,p = 0.28)之间的两组。结论:在STEMI中,阿片类药物与较差的血管造影结果相关,特别是术后timi2血流。然而,这一观察结果在临床上似乎并不重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
CiteScore
6.70
自引率
3.30%
发文量
38
审稿时长
>12 weeks
期刊介绍: Promoting rational therapy within the discipline of cardiology, the American Journal of Cardiovascular Drugs covers all aspects of the treatment of cardiovascular disorders, particularly the place in therapy of newer and established agents. Via a program of reviews and original clinical research articles, the journal addresses major issues relating to treatment of these disorders, including the pharmacology, efficacy and adverse effects of the major classes of drugs; information on newly developed drugs and drug classes; the therapeutic implications of latest research into the aetiology of cardiovascular disorders; and the practical management of specific clinical situations. The American Journal of Cardiovascular Drugs offers a range of additional enhanced features designed to increase the visibility, readership and educational value of the journal’s content. Each article is accompanied by a Key Points summary, giving a time-efficient overview of the content to a wide readership. Articles may be accompanied by plain language summaries to assist patients, caregivers and others in understanding important medical advances. The journal also provides the option to include various other types of enhanced features including slide sets, videos and animations. All enhanced features are peer reviewed to the same high standard as the article itself. Peer review is conducted using Editorial Manager®, supported by a database of international experts. This database is shared with other Adis journals.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信