Study Design Summary: Multicenter observational retrospective study of NSTEMI and unstable angina patients in US split into morphine vs no morphine and morphine vs nitroglycerin groups.
Notes: Morphine vs no morphine: More patients in the morphine groups had death, MI, CHF and cariogenic shock events on admission. The groups were fairly unbalanced with the morphine group being the sicker group, but the no morphine group had larger percentage pf patients with history of CHF.
Morphine vs nitro: More death, MI, CHF, and cariogenic shock in the morphine group. The groups were fairly unbalanced with the nitroglycerin group being overall sicker, however more patients in the morphine and nitroglycerin group had history of CHF.
Quote from discussion section of paper: “In one study patients with CAD awaiting bypass surgery, morphine caused 13% reduction in coronary blood flow. In fact, in animal studies, morphine has been demonstrated quite conclusively to actually increase myocardial infarction size.”
Study Conclusion: Use of morphine either alone or in combination with nitroglycerin for patients presenting with NSTEMI and unstable angina was associated with higher mortality.
Fusion Beat Bottom Line Impression: The study demonstrates an association between morphine and mortality in patients with NSTEMI and unstable angina and needs to be evaluated further for causality.
A Fusion Beat 