ST-segment elevation myocardial infarction (STEMI) is usually caused by a ruptured atherosclerotic plaque, with subsequent thrombus formation. Platelet inhibition and primary percutaneous coronary intervention (PCI) are essential treatments. Morphine, used to relieve pain and anxiety in STEMI patients, delays the onset of P2Y12 inhibitors. This study aimed to further explore the association between platelet activity and morphine treatment in patients with STEMI. In this sub-study of the VALIDATE-SWEDHEART trial, 89 STEMI patients treated with ticagrelor, and primary PCI were included. Platelet aggregation and biomarkers of platelet activity, coagulation, and inflammation (sP-selectin, thrombin-antithrombin complexes, prothrombin fragments 1 + 2, CD40L, CRP, beta-thromboglobulin, and pentraxin3) were assessed at three time points: before, one, and twelve hours after PCI. Of the 89 patients, 40 received morphine before hospital arrival. There were no significant differences in age, sex, medical history, or coronary disease extent. One hour after PCI, ADP-induced (36 vs 61, p < .001), arachidonic acid-induced (20 vs 36, p = .003), collagen-induced (48 vs 60, p = .03) aggregation, and the proportion of high on-treatment ADP-induced platelet reactivity (27% vs 60%, p = .001) were significantly higher in morphine-treated patients. No significant differences were found before or 12 hours after PCI. No significant differences in platelet activity biomarkers were observed. Morphine increased platelet aggregation in STEMI patients but did not affect biomarkers.
Keywords: Aggregation; ST-segment elevation myocardial infarction; morphine; platelet; ticagrelor; troponin.
What is the context? ST-segment elevation myocardial infarction (STEMI) occurs due to the complete and persistent blockage of coronary arteries, disrupting blood flow to the heart.This blockage is often caused by the rupture of atherosclerotic plaques, leading to the formation of a thrombus.Standard treatment for STEMI includes platelet inhibition and primary percutaneous coronary intervention (PCI) to restore blood flow.Morphine is commonly used to alleviate pain and anxiety in patients with STEMI, but it has been shown to delay the effectiveness of P2Y12 platelet inhibitors.What is new? This study explored the relationship between morphine use and platelet activity in patients with STEMI.The research was part of the VALIDATE-SWEDHEART trial and included 89 patients treated with ticagrelor and PCI.Platelet aggregation and biomarkers of platelet activity, coagulation, and inflammation were measured at three time points: before PCI, one hour after PCI, and twelve hours after PCI.Key findings include:One hour after PCI, patients treated with morphine had significantly higher platelet aggregation compared to those who did not receive morphine.There were no significant differences in biomarkers of platelet activity, coagulation, or inflammation between the two groups at any time point.What is the impact? This study indicates that while morphine increases platelet aggregation in patients with STEMI, it does not lead to changes in biomarkers of platelet activity, coagulation, or inflammation.These findings suggest that morphine, despite delaying the action of anti-platelet medications, may not adversely affect the underlying biological processes involved in blood clotting and inflammation.Understanding this interaction is crucial for safely managing pain in patients with STEMI while ensuring effective anti-platelet therapy.