Correlations Between Morphine Use and Adverse Outcomes in Acute ST-Segment Elevation Myocardial Infarction with Acute Heart Failure: A Retrospective Study

Background: The available data regarding the safety of morphine use in cases of STEMI with AHF (Killip ≥2) remain insufficient. The aim of the study was to further examine the safety of intravenous morphine in patients with STEMI and AHF over 1 year of follow-up after primary percutaneous coronary intervention (PPCI). Methods: 275 consecutive patients with STEMI and AHF were included and divided into groups that did or did not receive in-hospital intravenous morphine. Endpoints included major adverse cardiovascular events (MACEs) and the need for invasive mechanical ventilation during hospitalization and 1 year of follow-up. Results: The in-hospital occurrences of cardiac death and cardiogenic shock were much higher in patients who received morphine than that those who did not (15.20% vs 6.67%, p=0.035; odds ratio [OR]=2.509, 95% confidence interval [CI] 1.121–5.620, and 14.40% vs 6.00%, p=0.033; OR=2.636, 95% CI 1.139-6.097, respectively). Additionally, more patients in the group treated with morphine experienced the secondary outcome of in-hospital invasive mechanical ventilation compared with the group not treated with morphine (19.20% vs 10.67%, p=0.031; OR=2.308, 95% CI 1.138–4.684). However, no difference between-group differences were observed for the incidence of MACEs, cardiac death, or all-cause death over 1 year of follow-up. Conclusions: Intravenous morphine administration is highly correlated with in-hospital MACEs and the need for additional invasive mechanical ventilation in STEMI patients with AHF after PPCI, but not for long-time adverse outcomes.