• Etienne Puymirat, Lionel Lamhaut, Nicolas Bonnet, Nadia Aissaoui, Patrick Henry, Guillaume Cayla, Simon Cattan, Gabriel Steg, Laurent Mock, Gregory Ducrocq, Patrick Goldstein, François Schiele, Eric Bonnefoy-Cudraz, Tabassome Simon, and Nicolas Danchin.
• Department of Cardiology, European Hospital of Georges Pompidou, Assistance Publique des Hôpitaux de Paris (AP-HP), 15-20 rue Leblanc, Paris 75015, France University Paris Descartes, Paris, France INSERM U-970, Paris, France etiennepuymirat@yahoo.fr etienne.puymirat@egp.aphp.fr.
• Eur. Heart J. 2016 Apr 1; 37 (13): 1063-71.

AimsThe use of opioids is recommended for pain relief in patients with myocardial infarction (MI) but may delay antiplatelet agent absorption, potentially leading to decreased treatment efficacy.Methods And ResultsIn-hospital complications (death, non-fatal re-MI, stroke, stent thrombosis, and bleeding) and 1-year survival according to pre-hospital morphine use were assessed in 2438 ST-elevation MI (STEMI) patients from the French Registry of Acute ST-elevation and non-ST-elevation Myocardial Infarction (FAST-MI) 2010. The analyses were replicated in the 1726 STEMI patients of the FAST-MI 2005 cohort, in which polymorphisms of CYP2C19 and ABCB1 had been assessed. Specific subgroup analyses taking into account these genetic polymorphisms were performed in patients pre-treated with thienopyridines. The 453 patients (19%) receiving morphine pre-hospital were younger, more often male, with a lower GRACE score and higher chest pain levels. After adjustment for baseline differences, in-hospital complications and 1-year survival (hazard ratio = 0.69; 95% confidence interval: 0.35-1.37) were not increased according to pre-hospital morphine use. After propensity score matching, 1-year survival according to pre-hospital morphine was also similar. Consistent results were found in the replication cohort, including in those receiving pre-hospital thienopyridines and whatever the genetic polymorphisms of CYP2C19 and ABCB1.ConclusionIn two independent everyday-life cohorts, pre-hospital morphine use in STEMI patients was not associated with worse in-hospital complications and 1-year mortality.Clinical Trial RegistrationClinicaltrials.gov identifier: NCT00673036 (FAST-MI 2005); NCT01237418 (FAST-MI 2010).Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

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