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(556) Association Between Opioid Analgesia and Delays to Cardiac Catheterization of Patients With Occlusion Myocardial Infarction


Authors:

Alexander Bracey, MD – Attending Physician, Stony Brook University

H Pendell Meyers, MD – Fellow, Stony Brook University

Daniel D. Singer, MD – Resident, SUNY at Stony Brook

Wei Li, MD – Resident, Stony Brook University

Steven Smith, MD – Professor, Hennepin County Medical Center

Adam Singer, MD – Professor and Vice Chairman for Research, Stony Brook University

Catherine Silberstein

Abstract:

Background and Objectives: Emergent cardiac catheterization (CC) for acute coronary syndrome (ACS) is recommended with ongoing ischemic symptoms regardless of ECG. Opioids are sometimes given for ACS, though evidence has shown an association between opioids and mortality. We hypothesized that opioids may mask ongoing symptoms of unrecognized coronary Occlusion MI (OMI) delaying emergent reperfusion. Our aim was to explore the association between opioid administration, delays to CC, and outcomes in ACS.

Methods: We conducted a retrospective, observational, case-control study of ED patients with suspected ACS who underwent CC at a large academic center during a 4 month period in 2018. Patients were grouped based on whether they received opioids prior to CC. The main outcomes were door-to-balloon times (DTBT) and peak troponins (T). Outcomes were compared between groups using parametric or non-parametric tests as necessary.

Results: 271 patients underwent CC. Mean age was 65, 31.7% were female, and 85.2% were white. Of those, 228 (84.1%) did not receive opioids prior to CC. The 43 (15.8%) patients that received opioids had a mean DTBT of 2,123 minutes compared to 1,643 minutes in those without opioids (P<0.001). Median peak T were 0.55 ng/mL vs. 1.35 ng/mL in patients without and with opioids respectively, P<0.001. Of the 228 without opioids, 45 (19.7%) were found to have STEMI(-) OMI, while 20 (46.5%) of the 43 that did receive opioids were found to have STEMI(-) OMI (P<0.001). 65 (23.9%) patients were found to have STEMI(-) OMI at the time of CC. The 45 patients with STEMI(-) OMI without opioids had a DTBT of 75 minutes, vs. 684 minutes for the 25 STEMI(-) OMI patients with opioids (P<0.001).

Conclusion: The administration of opioids prior to CC in patients with suspected ACS is associated with longer DDTB, and greater peak troponins. The rate of OMI was more than double in those without compared with those with pre CC opioids. This may help explain worse outcomes in those receiving opioids.

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