Intra-coronary morphine versus placebo in the treatment of acute ST-segment elevation myocardial infarction: the MIAMI randomized controlled trial

BMC Cardiovascular Disorders

Dalila Bitari¹  Raphaele Arrouasse¹  Philippe Le Corvoisier¹  Saïd Ghostine²  Muriel Paul³  Etienne Audureau⁴  Jean-François Deux⁵  Jean-Luc Dubois-Randé⁶  Romain Gallet⁶  Emmanuel Teiger⁶  Alain Berdeaux⁶  Bijan Ghaleh⁶  Stéphane Champagne⁷  Gauthier Mouillet⁷  Julien Ternacle⁷  Pierre-François Lesault⁷ 

[1] Department VERDI, Inserm, CIC1430, AP-HP, Henri Mondor Hospital;Department of Cardiology, Marie-Lannelongue Hospital;Department of Pharmacy, AP-HP, Henri Mondor Hospital;Department of Public Health and CEPIA EA7376, AP-HP, Henri Mondor Hospital;Department of Radiology, AP-HP, Henri Mondor Hospital;Inserm, U955 team 3;Interventional Cardiology Unit, AP-HP, Henri Mondor Hospital;

关键词: STEMI;    Reperfusion injury;    Cardioprotection;    Infarct size;    Morphine;   

DOI  :  10.1186/s12872-018-0936-8

来源: DOAJ

【 摘 要 】

Abstract Background Experimental studies suggest that morphine may protect the myocardium against ischemia-reperfusion injury by activating salvage kinase pathways. The objective of this two-center, randomized, double-blind, controlled trial was to assess potential cardioprotective effects of intra-coronary morphine in patients with ST-segment elevation myocardial infarction (STEMI) referred for primary percutaneous intervention. Methods Ninety-one patients with STEMI were randomly assigned to intracoronary morphine (1 mg) or placebo at reperfusion of the culprit coronary artery. The primary endpoint was infarct size/left ventricular mass ratio assessed by magnetic resonance imaging on day 3–5. Secondary endpoints included the areas under the curve (AUC) for troponin T and creatine kinase over three days, left ventricular ejection fraction assessed by echocardiography on days 1 and 6, and clinical outcomes. Results Infarct size/left ventricular mass ratio was not significantly reduced by intracoronary morphine compared to placebo (27.2% ± 15.0% vs. 30.5% ± 10.6%, respectively, p = 0.28). Troponin T and creatine kinase AUCs were similar in the two groups. Morphine did not improve left ventricular ejection fraction on day 1 (49.7 ± 10.3% vs. 49.3 ± 9.3% with placebo, p = 0.84) or day 6 (48.5 ± 10.2% vs. 49.0 ± 8.5% with placebo, p = 0.86). The number of major adverse cardiac events, including stent thrombosis, during the one-year follow-up was similar in the two groups. Conclusions Intracoronary morphine at reperfusion did not significantly reduce infarct size or improve left ventricular systolic function in patients with STEMI. Presence of comorbidities in some patients may contribute to explain these results. Trial registration ClinicalTrials.gov, NCT01186445 (date of registration: August 23, 2010).

【 授权许可】

Unknown