Morphine for chest pain increases death risk

Roman Bystrianyk · medicine forum Guru Joined: 02 May 2005 Posts: 454

"Morphine for chest pain increases death risk", Medical News Today, May
6, 2005,
Link: http://www.medicalnewstoday.com/medicalnews.php?newsid=23939

While patients hospitalized for a heart attack have long been treated
with morphine to relieve chest pain, an analysis by researchers from
the Duke Clinical Research Institute has shown that these patients have
almost a 50 percent higher risk of dying.

The researchers call for a randomized clinical trial to confirm their
analysis. Meanwhile, they advise cardiologists to begin treatment with
sufficient doses of nitroglycerin to relieve pain before resorting to
morphine.

In their analysis of the clinical data and outcomes of more than 57,000
high-risk heart attack patients -- 29.8 percent of whom received
morphine within the first 24 hours of hospitalization -- the
researchers found that those who received morphine had a 6.8 percent
death rate, compared to 3.8 percent for those receiving nitroglycerin.
The increase in mortality persisted even after adjustment for the
patients' baseline clinical risk.

The results of the Duke were published as a fast-track article in the
American Heart Journal.

"The results of this analysis raise serious concerns about the safety
of the routine use of morphine in this group of heart patients," said
Duke cardiologist Trip Meine, M.D., the study's lead author. "Since
randomized clinical trials evaluating the safety or effectiveness of
morphine for these patients have not been conducted, official
guidelines for its use are based solely on expert conjecture. Given the
adverse outcomes associated with morphine use found in our analysis, a
randomized clinical trial is in order."

Morphine was first used to relieve the chest pain associated with heart
attacks in 1912 and has been used regularly ever since. Nitroglycerin
has been used for more than 130 years for the relief of chest pain,
also known as unstable angina. It works by relaxing blood vessels and
allowing blood flow to increase.

"Nitroglycerin has a physiological effect that may, at least
temporarily, influence the underlying ischemia," Meine said. "Morphine,
on the other hand, doesn't do anything about what is actually causing
the pain. It just masks it, and may, in fact, make the underlying
disease worse.

"Morphine has the well-known and potentially harmful side effects of
depressing respiration, reducing blood pressure and slowing heart
rate," he continued. "These side effects could explain the worse
outcomes in patients whose heart function has already been compromised
by disease."

For their analysis, the researchers consulted the nationwide quality
improvement initiative named CRUSADE (Can Rapid Risk Stratification of
Unstable Angina Patients Suppress Adverse Outcomes with Early
Implementation of the American College of Cardiology and AHA
Guidelines) The registry continually collects data from more than 400
hospitals on outcomes and on the use of proven drugs and procedures
used to restore blood flow to the heart.

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