A-14 | Morphine and P2Y12 inhibitors in Acute Coronary Syndrome: A Meta-Analysis

Morphine is used to control pain in ACS but reduces P2Y12 inhibition. It is not known if this modulation of platelet inhibition appreciably affects clinical outcomes. We screened 974 articles and identified eleven studies that met eligibility criteria for meta-analysis. Outcomes included fifteen metrics across clinical, angiographic, and pharmacologic disciplines. A random effects model assessed heterogeneity between studies. The opiate group showed decreased achievement of post-procedural TIMI 2 flow relative to placebo (0.5299 to 0.9202, p=0.0108, I2 =0.0%). All other metrics, listed below, showed no statistically significant difference between groups: infarct size, microvascular obstruction, microvascular/salvage index, absence of pre-PCI TIMI 3 flow, postprocedural TIMI 2 flow, postprocedural TIMI 3 flow, all-cause mortality, stroke, stent thrombosis, heart failure, cardiogenic shock, unstable angina and left ventricular ejection fraction. In ACS, opiates correlate with worse angiographic outcomes, specifically postprocedural TIMI 2 flow. However, this observation does not appear to be clinically consequential.