Morphine use and myocardial reperfusion in patients with acute myocardial infarction treated with primary PCI

Impact of Morphine Treatment on Infarct Size and Reperfusion Injury in Acute Reperfused ST-Elevation Myocardial Infarction

“…Patients with not completely occluded vessels (TIMI flow ≥I) may develop smaller infarct size, regardless of protection strategy and this may also influence the cardioprotective effect of morphine. These findings are in accordance with evidence that opioid agonists may be involved in favorable cardioprotective effects on the myocardium [13][14][15][16][17][18]28]. In animal models of myocardial reperfusion injury, morphine preconditioning improved cardiac function and reduced post-infarction remodeling [15,[28][29][30].…”

“…However, previous studies reported inconsistent results regarding the effect of morphine on myocardial damage in patients with acute myocardial infarction [15][16][17][18] and were mainly limited by preclinical studies, non-randomized observational study designs, as well as the assessment of indirect parameters of reperfusion success, like ST-segment resolution, TIMI flow grade after PPCI or infarct size measurement by biomarkers. Our results support a potential cardioprotective effect of morphine in patients with early reperfusion, but larger randomized studies are needed to finally elucidate the true clinical significance on hard clinical outcomes.…”

“…In contrast, there is also evidence that opioid agonists may be involved in favorable cardioprotective effects on the myocardium, with beneficial effects on all major determinants of ischemia-reperfusion injury (infarction/apoptosis, arrhythmogenesis, contractile dysfunction, inflammation) [12][13][14]. However, previous studies reported inconsistent results regarding the effect of morphine on myocardial damage in patients with acute myocardial infarction [15][16][17][18] and had several limitations including single-center design, small sample size, and indirect infarct size assessment. Cardiac magnetic resonance (CMR) imaging is the reference standard technique for the assessment of infarct size and reperfusion injury [19].The aim of this study was to comprehensively evaluate the impact of morphine treatment on infarct size and reperfusion injury assessed by CMR in an adequately-sized multicenter study of patients with acute STEMI undergoing PPCI.…”

Análise da interação farmacológica e eficácia da morfina perante pacientes com síndrome coronariana aguda: revisão sistemática / Analysis of pharmacological interaction and morphine efficacy in patients with acute coronary syndrome: systematic review

“…abalizados sobre o controle da dor para diminuição do consumo de oxigênio em um músculo que possui obstrução de condução hemodinâmica,. A analgesia além de diminuir a ativação simpática o que dilata os vasos periféricos, minimiza a lesão de reperfusão assim como a área de infarto (29,(36)(37)(38) . No entanto, esses efeitos estão sob questionamento, não somente pela eficácia de sua ação protetora, mas também pelo pleiotropismo farmacológico que esse analgésico carrega em contato com drogas inibidoras de agregação plaquetárias (39) .…”

“…A descrição fisiopatológica apresentada acima para utilizar o analgésico, e por muito tempo defendida, compõe o peso de uma balança que está desequilibrando para o lado oposto. Atualmente pesquisadores estão demonstrando que existe relevância dos efeitos opioides na redução da função antiplaquetária (31) , devido o decréscimo de sua absorção intestinal, o que gera níveis plasmáticos reduzidos ou com atraso na curva de aumento no sangue (30,36) . Estas situações conduzem a um questionamento sobre a relevância analgésica em detrimento do efeito antiagregante, tão importante em pacientes com síndrome coronariana aguda (40) .…”