{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T08:18:48Z","timestamp":1778660328558,"version":"3.51.4"},"reference-count":22,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2020,7,19]],"date-time":"2020-07-19T00:00:00Z","timestamp":1595116800000},"content-version":"unspecified","delay-in-days":18,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Alfred Foundation"},{"name":"Paramedics Australia"},{"DOI":"10.13039\/501100007617","name":"Falck Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100007617","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2020,5,27]]},"published-print":{"date-parts":[[2020,7]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To characterise the relationship between opioid dose and myocardial infarct size in patients with ST elevation myocardial infarction (STEMI).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Patients given opioid treatment by emergency medical services with confirmed STEMI were included in this secondary, retrospective cohort analysis of the Air versus Oxygen in Myocardial Infarction (AVOID) study. Patients with cardiogenic shock were excluded. The primary endpoint was comparison of cardiac biomarkers as a measure of infarct size based on opioid dose (low \u22648.75\u2009mg, intermediate 8.76\u201315\u2009mg and high &gt;15\u2009mg of intravenous morphine equivalent dose).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>422 patients were included in the analysis. There was a significantly higher proportion of patients with Thrombolysis in Myocardial Infarction (TIMI) 0 or 1 flow pre-percutaneous coronary intervention (PCI) (94% vs 81%, p=0.005) and greater use of thrombus aspiration catheters (59% vs 30%, p&lt;0.001) in the high compared with low-dose opioid group. After adjustment for potential confounders, every 1\u2009mg of intravenous morphine equivalent dose was associated with a 1.4% (95% CI 0.2%, 2.7%, p=0.028) increase in peak creatine kinase; however, this was no longer significant after adjustment for TIMI flow pre-PCI.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Our study suggests no benefit of higher opioid dose and a dose-dependent signal between opioid dose and increased myocardial infarct size. Prospective randomised controlled trials are required to establish causality given that this may also be explained by patients with a greater ischaemic burden requiring higher opioid doses due to more severe pain. Future research also needs to focus on strategies to mitigate the opioid\u2013P2Y12 inhibitor interaction and non-opioid analgesia to treat ischaemic chest pain.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/openhrt-2020-001307","type":"journal-article","created":{"date-parts":[[2020,7,23]],"date-time":"2020-07-23T02:17:50Z","timestamp":1595470670000},"page":"e001307","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":13,"title":["Prehospital opioid dose and myocardial injury in patients with ST elevation myocardial infarction"],"prefix":"10.1136","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4775-6708","authenticated-orcid":false,"given":"Himawan","family":"Fernando","sequence":"first","affiliation":[{"name":"Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia"},{"name":"Central Clinical School, Monash University, Melbourne, Victoria, Australia"},{"name":"Atherothrombosis and Vascular Biology, Baker Heart Research Institute, Melbourne, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ziad","family":"Nehme","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia"},{"name":"Research & Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karlheinz","family":"Peter","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia"},{"name":"Atherothrombosis and Vascular Biology, Baker Heart Research Institute, Melbourne, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen","family":"Bernard","sequence":"additional","affiliation":[{"name":"Research & Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia"},{"name":"Intensive Care Unit, Alfred Hospital, Melbourne, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Stephenson","sequence":"additional","affiliation":[{"name":"Research & Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Janet","family":"Bray","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Cameron","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andris","family":"Ellims","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Alfred Hospital, Melbourne, Victoria, 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Effects of the peripheral opioid receptor antagonist methylnaltrexone on the pK and PD profiles of ticagrelor in patients with coronary artery disease treated with morphine. JACC Cardiovasc Interv 2019."},{"key":"2025081710364866000_7.2.e001307.20","doi-asserted-by":"crossref","first-page":"2126","DOI":"10.1055\/s-0038-1675605","article-title":"Metoclopramide administration as a strategy to overcome MORPHine-ticagrelOr interaction in patients with unstable angina PectorIS-The metamorphosis trial","volume":"118","author":"Sikora","year":"2018","journal-title":"Thromb Haemost"},{"key":"2025081710364866000_7.2.e001307.21","doi-asserted-by":"crossref","first-page":"1661","DOI":"10.1161\/CIRCULATIONAHA.118.038317","article-title":"Platelet inhibition with cangrelor and crushed ticagrelor in patients with ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention","volume":"139","author":"Franchi","year":"2019","journal-title":"Circulation"},{"key":"2025081710364866000_7.2.e001307.22","doi-asserted-by":"publisher","DOI":"10.1186\/1745-6215-16-1"}],"container-title":["Open Heart"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/openhrt-2020-001307","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,17]],"date-time":"2025-08-17T17:37:01Z","timestamp":1755452221000},"score":1,"resource":{"primary":{"URL":"https:\/\/openheart.bmj.com\/lookup\/doi\/10.1136\/openhrt-2020-001307"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,7]]},"references-count":22,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2020,7,22]]},"published-print":{"date-parts":[[2020,7]]}},"alternative-id":["10.1136\/openhrt-2020-001307"],"URL":"https:\/\/doi.org\/10.1136\/openhrt-2020-001307","relation":{},"ISSN":["2053-3624"],"issn-type":[{"value":"2053-3624","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,7]]}}}