Correlations between Morphine Use and Adverse Outcomes in Acute ST-Segment Elevation Myocardial Infarction with Acute Heart Failure: a retrospective study 

Background: Studies examining the safety of intravenous morphine use for acute heart failure (AHF) have reported inconsistent results. Objective: The comprehensive meta-analysis assessed and compared the clinical outcomes of intravenous morphine use in AHF. Methods: : We formally searched electronic databases before June 2020 to identify potential studies. All clinical trials were eligible for inclusion if they compared intravenous morphine or not in patients with AHF. Results: : 3 propensity-matched cohorts and 2 retrospective analysis with a total of 151867 patients met the inclusion criteria were included in our meta-analysis (intravenous morphine group=22072, without morphine group=127895). The use of intravenous morphine was associated with increased risk of in-hospital mortality [over all odds ratio (OR)=5.49, 95% confidence interval (CI) 5.20 to 5.79, p<0.001, I 2 =96.7%; subgroup analysis: OR=1.60, 95%CI 1.27-2.02, I 2 =0%; OR=1.53, 95%CI 1.20-1.96, I 2 =7%] and invasive mechanical ventilation (OR=6.08, 95% CI 5.79 to 6.40, p<0.001, I 2 =94.2%; subgroup analysis: OR=1.74, 95%CI 1.21-2.49, I 2 =62.3%). However, there was no significant association of longtime time mortality with intravenous morphine (Hazards ratio =1.17; 95% CI 0.99–1.36, p=0.14; I 2 32%). Conclusion: In AHF patients, intravenous morphine administration for relieving dyspnea was associated with in-hospital mortality and invasive mechanical ventilation, but not for longtime mortality.