Evidence map›Paper›PMID 32719075›Full record

Observational studyOpen heart2020

Prehospital opioid dose and myocardial injury in patients with ST elevation myocardial infarction.

Himawan Fernando, Ziad Nehme, Karlheinz Peter, Stephen Bernard, Michael Stephenson, Janet Bray, Peter Cameron, Andris Ellims, Andrew Taylor, David M Kaye and 3 more

Open access · goldAbstract readMulticenter StudyObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Open heart, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
1.8field-weighted citation impact, top 13% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 13 citations in OpenAlex.

  1. Article
  2. Review
  3. P2YFrontiers in cardiovascular medicine · 2022
    Review
  4. Article
  5. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors at 3 institutions in 1 country.

Himawan FernandoDepartment of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia.ORCID 0000-0002-4775-6708
Ziad NehmeDepartment of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Karlheinz PeterDepartment of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia.
Stephen BernardResearch & Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia.
Michael StephensonResearch & Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia.
Janet BrayDepartment of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Peter CameronDepartment of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Andris EllimsDepartment of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia.
Andrew TaylorDepartment of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia.
David M KayeDepartment of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia.
Karen SmithDepartment of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Dion StubDepartment of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia d.stub@alfred.org.au.ORCID 0000-0001-8686-2709
AVOID investigators
The Alfred Hospital · AUAmbulance Victoria · AUMonash University · AU

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo characterise the relationship between opioid dose and myocardial infarct size in patients with ST elevation myocardial infarction (STEMI).

methodsPatients given opioid treatment by emergency medical services with confirmed STEMI were included in this secondary, retrospective cohort analysis of the Air versus Oxygen in Myocardial Infarction (AVOID) study. Patients with cardiogenic shock were excluded. The primary endpoint was comparison of cardiac biomarkers as a measure of infarct size based on opioid dose (low ≤8.75 mg, intermediate 8.76-15 mg and high >15 mg of intravenous morphine equivalent dose).

results422 patients were included in the analysis. There was a significantly higher proportion of patients with Thrombolysis in Myocardial Infarction (TIMI) 0 or 1 flow pre-percutaneous coronary intervention (PCI) (94% vs 81%, p=0.005) and greater use of thrombus aspiration catheters (59% vs 30%, p<0.001) in the high compared with low-dose opioid group. After adjustment for potential confounders, every 1 mg of intravenous morphine equivalent dose was associated with a 1.4% (95% CI 0.2%, 2.7%, p=0.028) increase in peak creatine kinase; however, this was no longer significant after adjustment for TIMI flow pre-PCI.

conclusionsOur study suggests no benefit of higher opioid dose and a dose-dependent signal between opioid dose and increased myocardial infarct size. Prospective randomised controlled trials are required to establish causality given that this may also be explained by patients with a greater ischaemic burden requiring higher opioid doses due to more severe pain. Future research also needs to focus on strategies to mitigate the opioid-P2Y12 inhibitor interaction and non-opioid analgesia to treat ischaemic chest pain.

Indexed as

Emergency Medical ServicesPercutaneous Coronary InterventionThrombectomyAgedAnalgesics, OpioidBiomarkersCreatine KinaseFemaleHumansMaleMiddle AgedMyocardiumRandomized Controlled Trials as TopicRetrospective StudiesST Elevation Myocardial InfarctionTime FactorsAnalgesics, OpioidBiomarkersCreatine KinaseTroponin Iantiplatelet treatmentcoronary intervention (PCI)myocardial ischaemia and infarction (IHD)platelet activationSTEMI

Identifiers

PMID32719075
PMCPMC7380835
OpenAlexW3044292551

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.