Morphine and Ticagrelor Interaction in Primary Percutaneous Coronary Intervention in ST-Segment Elevation Myocardial Infarction: ATLANTIC-Morphine

Frederic Lapostolle, Arnoud W. van't Hof, Christian W. Hamm, Olivier Stibbe, Patrick Ecollan, Jean-Philippe Collet, Johanne Silvain, Jens Flensted Lassen, Wim M. J. M. Heutz, Leonardo Bolognese, Warren J. Cantor, Angel Cequier, Mohamed Chettibi, Shaun G. Goodman, Christopher Hammett, Kurt Huber, Magnus Janzon, Bela Merkely, Robert F. Storey, Jur ten BergUwe Zeymer, Muriel Licour, Anne Tsatsaris, Gilles Montalescot*, Rachid Bougherbal, Mohamed Tahar Bouafia, Mohamed Chettibi, Djamaleddine Nibouche, Abdelkader Moklati, Ahmed Benalia, Messaad Krim, Christopher Hammett, Paul Garraby, Rohan Jayasinghe, Stephen Rashford, Kurt Huber, Thomas Neunteufl, Helmut Brussee, Hannes Alber, Franz Weidinger, Michael Baubin, Dieter Sebald, Warren Cantor, Ram Vijayaraghavan, Iqbal Bata, Andrea Lavoie, Jens Flensted Lassen, Jan Ravkilde, Lisette Okkels Jensen, Alf Mol Christensen, ATLANTIC Investigators

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


BackgroundMorphine adversely impacts the action of oral adenosine diphosphate (ADP)-receptor blockers in ST-segment elevation myocardial infarction (STEMI) patients, and is possibly associated with differing patient characteristics. This retrospective analysis investigated whether interaction between morphine use and pre-percutaneous coronary intervention (pre-PCI) ST-segment elevation resolution in STEMI patients in the ATLANTIC study was associated with differences in patient characteristics and management.MethodsATLANTIC was an international, multicenter, randomized study of treatment in the acute ambulance/hospital setting where STEMI patients received ticagrelor 180mgmorphine. Patient characteristics, cardiovascular history, risk factors, management, and outcomes were recorded.ResultsOpioids (97.6% morphine) were used in 921 out of 1862 patients (49.5%). There were no significant differences in age, sex or cardiovascular history, but more morphine-treated patients had anterior myocardial infarction and left-main disease. Time from chest pain to electrocardiogram and ticagrelor loading was shorter with morphine (both p=0.01) but not total ischemic time. Morphine-treated patients more frequently received glycoprotein IIb/IIIa inhibitors (p=0.002), thromboaspiration and stent implantation (both p

Original languageEnglish
Pages (from-to)173-183
Number of pages11
JournalAmerican Journal of Cardiovascular Drugs
Issue number2
Publication statusPublished - Apr 2019



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