• Guido Parodi, Benedetta Bellandi, Ioanna Xanthopoulou, Piera Capranzano, Davide Capodanno, Renato Valenti, Katerina Stavrou, Angela Migliorini, David Antoniucci, Corrado Tamburino, and Dimitrios Alexopoulos.
• From the Department of Heart and Vessels, Careggi University Hospital, Florence, Italy (G.P., B.B., R.V., A.M., D. Antoniucci); Post-graduate School in Cardiology, University of Florence, Italy (G.P.); Department of Cardiology, Patras University Hospital, Patras, Greece (I.X., K.S., D. Alexopoulos); and Cardiology Department, Ferrarotto Hospital, University of Catania, Catania, Italy (P.C., D.C., C.T.). parodiguido@gmail.com.
• Circ Cardiovasc Interv. 2015 Jan 1; 8 (1).

BackgroundMorphine is recommended in patients with ST-segment-elevation myocardial infarction, including those undergoing primary percutaneous coronary intervention. Suboptimal antiplatelet effect during and after primary percutaneous coronary intervention is associated with increased thrombotic complications. It was hypothesized a potential drug-drug interaction between morphine and antiplatelet agents. We sought to assess platelet inhibition after a loading dose of the currently recommended antiplatelet agents in ST-segment-elevation myocardial infarction patients according to morphine use.Methods And ResultsThree hundred patients undergoing primary percutaneous coronary intervention receiving either prasugrel (n = 95) or ticagrelor (n = 205) loading dose had platelet reactivity assessed by VerifyNow 1, 2, and 4 hours after loading dose. Patients treated with morphine (n = 95; 32%) had a higher incidence of vomit (15% versus 2%; P = 0.001). P2Y12 reactivity units 2 hours after the loading dose was 187 (153-221) and 133 (102-165) in patient with and without morphine (P < 0.001); the difference persisted after excluding patients with vomit (P < 0.0001). High residual platelet reactivity (P2Y12 reactivity units ≥ 208) at 2 hours was found in 53% and 29% patients with and without morphine (P < 0.001) and without difference between prasugrel and ticagrelor patients. The independent predictors of high residual platelet reactivity at 2 hours were morphine use (odds ratio, 2.91 [1.71-4.97]; P < 0.0001) and age (odds ratio, 1.03 [1.01-1.05]; P = 0.010). Morphine remained associated with high residual platelet reactivity after propensity score adjustment (c-statistic, 0.68; 95% confidence interval, 0.66-0.70; P = 0.879 for Hosmer-Lemeshow test).ConclusionsIn patients with ST-segment-elevation myocardial infarction, morphine use is associated with a delayed onset of action of the oral antiplatelet agents. This association persisted after adjusting for the propensity to receive morphine and after excluding patients with vomit.© 2014 American Heart Association, Inc.

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