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The prevalence and outcomes of morphine use in the initial management of patients with acute myocardial infarction

Landis, Parker (2019) The prevalence and outcomes of morphine use in the initial management of patients with acute myocardial infarction. Undergraduate Thesis, University of Pittsburgh. (Unpublished)

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Background: Morphine has been historically used for the initial management of pain in patients with suspected acute myocardial infarction (MI). There is controversial evidence that suggests that morphine use is associated with adverse outcomes in both ST-elevation and non-ST-elevation MI. Purpose: We sought to define the prevalence and outcomes of morphine use in the initial management of patients with suspected acute MI in the emergency department. Theoretical Framework: Some studies suggest that morphine delays and attenuates the action of anticoagulants in patients with MI, which might lead to adverse cardiac outcomes. Methods: This was a secondary analysis of Electrocardiographic Methods for the Prompt Identification of Coronary Events (EMPIRE) study. EMPIRE was a prospective, observational, cohort study that enrolled consecutive chest pain patients transported by ambulance to three UPMC-affiliated tertiary care hospitals. Pertinent clinical data were obtained from charts, including intravenous morphine administration up to procedural intervention (independent variable). The presence of the following clinical outcomes (dependent variables) was adjudicated by two independent reviewers: infarct size (defined by peak troponin level), myocardial dysfunction (defined by left ventricular ejection fraction), and major adverse cardiac events (MACE, defined as death, fatal ventricular arrhythmia, acute heart failure, pulmonary edema, cardiogenic shock, reinfarction, or repeat catheterization within 30 days of indexed admission). Results: Our sample included 155 patients with confirmed acute MI (age 64±16, 42% females, 29% Blacks). Patients who received morphine (n=58, 37%) were older and had higher pain scores, but there were no other baseline differences clinical characteristics. In multivariate analyses, morphine use was not associated with infarct size, myocardial dysfunction, or MACE after controlling for MI type and other potential confounders. Conclusions: In this cohort, we found that morphine use in the initial management of acute MI is not associated with increased risk of adverse cardiac outcomes.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Landis, ParkerPTL10@pitt.eduPTL10
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairAl-Zaiti,
Committee MemberFrisch,
Committee MemberRen,
Committee MemberZegre-Hemsey,
Thesis AdvisorAl-Zaiti,
Date: 9 April 2019
Date Type: Publication
Defense Date: 28 November 2018
Approval Date: 9 April 2019
Submission Date: 29 March 2019
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Number of Pages: 45
Institution: University of Pittsburgh
Schools and Programs: David C. Frederick Honors College
School of Nursing > Nursing
Degree: BSN - Bachelor of Science in Nursing
Thesis Type: Undergraduate Thesis
Refereed: Yes
Uncontrolled Keywords: Chest pain Acute myocardial infarction Morphine STEMI
Date Deposited: 09 Apr 2019 14:17
Last Modified: 09 Apr 2019 14:17


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