# Morfine en CV-uitkomsten bij NSTE-ACS: JACC analyse

*geplaatst 2020-01-28 · Algemeen · Journal of the American College of Cardiology · doi 10.1016/j.jacc.2019.11.035 · https://hartvaat.nl/2020/01/28/morfine-en-cv-uitkomsten-bij-nste-acs-jacc-analyse/*

Analyse naar het effect van morfinegebruik op cardiovasculaire uitkomsten bij NSTE-ACS patiënten die angiografie ondergaan.

## English: Morphine and Cardiovascular Outcomes Among Patients With Non-ST-Segment Elevation Acute Coronary Syndromes Undergoing Coronary Angiography.

This analysis examined the effect of morphine use on cardiovascular outcomes in NSTE-ACS patients undergoing angiography, providing clinical outcome data on the opioid-antiplatelet drug interaction concern.

## Abstract (original, from the publication)

BACKGROUND: Mechanistic studies have shown that morphine blunts the antiplatelet effects of oral adenosine diphosphate receptor blockers. However, the clinical relevance of this interaction is controversial. OBJECTIVES: This study sought to explore the association between morphine and ischemic events in 5,438 patients treated with concomitant clopidogrel presenting with non-ST-segment elevation acute coronary syndromes (NSTEACS) in the EARLY ACS (Early Glycoprotein IIb/IIIa Inhibition in Patients With Non-ST-Segment Elevation Acute Coronary Syndrome) trial. Patients not treated with clopidogrel (n = 3,462) were used as negative controls. METHODS: Endpoints were the composite of death, myocardial infarction (MI), recurrent ischemia, or thrombotic bailout at 96 h (4-way endpoint) and the composite of death or MI at 30 days. RESULTS: In patients treated with clopidogrel, morphine use was associated with higher rates of the 4-way endpoint at 96 h (adjusted odds ratio [OR]: 1.40; 95% confidence interval [CI]: 1.04 to 1.87; p = 0.026). There was a trend for higher rates of death or MI at 30 days (adjusted OR: 1.29; 95% CI: 0.98 to 1.70; p = 0.072), driven by events in the first 48 h (adjusted hazard ratio: 1.54; 95% CI: 1.07 to 2.23; p = 0.021). In patients not treated with clopidogrel, morphine was not associated with either the 4-way endpoint at 96 h (adjusted OR: 1.05; 95% CI: 0.74 to 1.49; p = 0.79; pinteraction = 0.36 ) or death or MI at 30 days (adjusted OR: 1.07; 95% CI: 0.77 to 1.48; p = 0.70; pinteraction = 0.46). CONCLUSIONS: When used concomitantly with clopidogrel pre-treatment, morphine was associated with higher rates of ischemic events in patients with NSTEACS. (EARLY ACS: Early Glycoprotein IIb/IIIa Inhibition in Patients With Non-ST-Segment Elevation Acute Coronary Syndrome; NCT00089895).

Auteurs: Remo H M Furtado, José C Nicolau, Jianping Guo, Kyungah Im, Jennifer A White, Marc S Sabatine, L Kristin Newby, Robert P Giugliano

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Bron: Journal of the American College of Cardiology, https://doi.org/10.1016/j.jacc.2019.11.035. Bijgewerkt 2026-07-03T13:27:34Z. Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.