Opioids in Critically Ill Acute Myocardial Infarction Patients: A Retrospective Analysis of the MIMIC-IV Database.

Abstract

Background: Opioids are the most commonly prescribed analgesic for patients with critically ill acute myocardial infarction (AMI). Unfortunately, inconsistent findings and limited evidence leave healthcare providers uncertain about whether these drugs offer more benefit or harm. Hence, the present study aimed to evaluate the impact of opioid use in AMI patients admitted to the intensive care unit.

Methods and results: A total of 5669 critically ill AMI patients' data were extracted from the MIMIC-IV databases. Of which, 4044 patients received opioid analgesics, while 1625 did not. The primary outcome was an association between different types of opioids and all-cause mortality at 30, 90, and 365 days. During follow-up, patients who received opioids had significantly higher mortality rates compared to those who did not (30-day: 20.3% vs. 10.1%; 90-day: 28.0% vs. 15.8%; 365-day: 35.2% vs. 26.4%; all p < 0.001). After propensity score matching, multivariable Cox regression analysis identified morphine as the only opioid significantly associated with increased all-cause mortality at 30 days (HR 2.693 [95%CI 2.144-3.383], p < 0.001), 90 days (HR 2.151 [95%CI 1.757-2.632], p < 0.001), and 365 days (HR 1.709 [95%CI 1.435-2.036], p < 0.001). Furthermore, feature selection using the Boruta algorithm and SHAP summary plot highlighted opioid use, particularly morphine, as a key determinant of cumulative mortality.

Conclusions: Opioid use was a significant predictor of mortality in critically ill AMI patients. Notably, only morphine was independently associated with an increased risk of both short- and long-term mortality.