Clinical InvestigationAssociation of intravenous morphine use and outcomes in acute coronary syndromes: Results from the CRUSADE Quality Improvement Initiative
Section snippets
Patients
Patients entered in the CRUSADE database from January 2001 through June 2003 were evaluated for this analysis. CRUSADE is a multidisciplinary quality improvement initiative for acute coronary syndrome patients across 443 emergency departments and medical centers. Patients included in the CRUSADE Initiative have ischemic symptoms at rest within 24 hours prior to presentation and high-risk features including ST-segment depression ≥0.5 mm, transient ST-segment elevation 0.5-1.0 mm (lasting for <10
Morphine versus no morphine: Baseline characteristics and treatment
In this cohort of 57,039 high-risk patients with NSTE ACS, 17,003 (29·8%) patients were treated with morphine within the first 24 hours following hospital presentation. Patients who received morphine had higher incidences of ST-segment depression, transient ST-segment elevation, and positive cardiac markers (Table I).
Patients who received morphine were more likely to receive evidence-based medications and treatments than were patients who did not receive morphine. Patients receiving morphine
Discussion
We evaluated >57,000 patients presenting to US hospitals with NSTE ACS and demonstrated that patients treated with morphine had a higher risk of death and other adverse clinical outcomes even though these patients were more likely to be treated with evidence-based medications and to undergo invasive cardiac procedures. These findings persisted even when we controlled for the concomitant use of IV nitroglycerin (which may designate higher risk patients with ongoing ischemic symptoms and signs of
References (18)
- et al.
ACC/AHA guidelines for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Unstable Angina)
J Am Coll Cardiol
(2000) - et al.
Comparison of nalbuphine hydrochloride versus morphine sulfate for acute myocardial infarction with elevated pulmonary artery wedge pressure
Am J Cardiol
(1988) Angina pectoris
(1923)- et al.
Longitudinal data analysis using generalized linear models
Biometrika
(1986) Estimating causal effects of treatments in randomized and nonrandomized studies
J Educ Psychol
(1974)- et al.
The central role of the propensity score in observational studies for causal events
Biometrika
(1983) - et al.
Haemodynamic effects of morphine in patients with acute myocardial infarction
Br Heart J
(1965) - et al.
Editorial: Analgesia in myocardial infarction
Br Heart J
(1974) - et al.
The effect of morphine on blood pressure and cardiac output in patients with acute myocardial infarction
Acta Med Scand
(1969)
Cited by (0)
CRUSADE is funded by Millennium Pharmaceuticals, Inc., and Schering Corporation. Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership provides an unrestricted grant in support of the program.