Correlates of pre-hospital morphine use in ST-elevation myocardial infarction patients and its association with in-hospital outcomes and long-term mortality: the FAST-MI (French Registry of Acute ST-elevation and non-ST-elevation Myocardial Infarction) programme

Eur Heart J. 2016 Apr 1;37(13):1063-71. doi: 10.1093/eurheartj/ehv567. Epub 2015 Nov 17.


Aims: The use of opioids is recommended for pain relief in patients with myocardial infarction (MI) but may delay antiplatelet agent absorption, potentially leading to decreased treatment efficacy.

Methods and results: In-hospital complications (death, non-fatal re-MI, stroke, stent thrombosis, and bleeding) and 1-year survival according to pre-hospital morphine use were assessed in 2438 ST-elevation MI (STEMI) patients from the French Registry of Acute ST-elevation and non-ST-elevation Myocardial Infarction (FAST-MI) 2010. The analyses were replicated in the 1726 STEMI patients of the FAST-MI 2005 cohort, in which polymorphisms of CYP2C19 and ABCB1 had been assessed. Specific subgroup analyses taking into account these genetic polymorphisms were performed in patients pre-treated with thienopyridines. The 453 patients (19%) receiving morphine pre-hospital were younger, more often male, with a lower GRACE score and higher chest pain levels. After adjustment for baseline differences, in-hospital complications and 1-year survival (hazard ratio = 0.69; 95% confidence interval: 0.35-1.37) were not increased according to pre-hospital morphine use. After propensity score matching, 1-year survival according to pre-hospital morphine was also similar. Consistent results were found in the replication cohort, including in those receiving pre-hospital thienopyridines and whatever the genetic polymorphisms of CYP2C19 and ABCB1.

Conclusion: In two independent everyday-life cohorts, pre-hospital morphine use in STEMI patients was not associated with worse in-hospital complications and 1-year mortality.

Clinical trial registration: identifier: NCT00673036 (FAST-MI 2005); NCT01237418 (FAST-MI 2010).

Keywords: Acute myocardial infarction; Morphine; Opioids; ST-elevation myocardial infarction.

Publication types

  • Multicenter Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • ATP Binding Cassette Transporter, Subfamily B / genetics
  • Aged
  • Analgesics, Opioid / therapeutic use*
  • Cytochrome P-450 CYP2C19 / genetics
  • Drug Interactions / genetics
  • Emergency Medical Services / methods
  • Female
  • France / epidemiology
  • Hospitalization / statistics & numerical data
  • Humans
  • Male
  • Middle Aged
  • Morphine / therapeutic use*
  • Non-ST Elevated Myocardial Infarction / drug therapy*
  • Non-ST Elevated Myocardial Infarction / genetics
  • Non-ST Elevated Myocardial Infarction / mortality
  • Pain / prevention & control
  • Platelet Aggregation Inhibitors / therapeutic use
  • Polymorphism, Genetic / genetics
  • Registries
  • Risk Factors
  • ST Elevation Myocardial Infarction / drug therapy*
  • ST Elevation Myocardial Infarction / genetics
  • ST Elevation Myocardial Infarction / mortality
  • Treatment Outcome


  • ABCB1 protein, human
  • ATP Binding Cassette Transporter, Subfamily B
  • Analgesics, Opioid
  • Platelet Aggregation Inhibitors
  • Morphine
  • Cytochrome P-450 CYP2C19

Associated data