Xie Siyuan, Sasmita Bryan Richard
Department of Laboratory Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
J Gen Intern Med. 2025 Jun 25. doi: 10.1007/s11606-025-09643-y.
Opioids are the most commonly prescribed analgesic for patients with critically ill acute myocardial infarction (AMI). Unfortunately, inconsistent findings and limited evidence leave healthcare providers uncertain about whether these drugs offer more benefit or harm. Hence, the present study aimed to evaluate the impact of opioid use in AMI patients admitted to the intensive care unit.
A total of 5669 critically ill AMI patients' data were extracted from the MIMIC-IV databases. Of which, 4044 patients received opioid analgesics, while 1625 did not. The primary outcome was an association between different types of opioids and all-cause mortality at 30, 90, and 365 days. During follow-up, patients who received opioids had significantly higher mortality rates compared to those who did not (30-day: 20.3% vs. 10.1%; 90-day: 28.0% vs. 15.8%; 365-day: 35.2% vs. 26.4%; all p < 0.001). After propensity score matching, multivariable Cox regression analysis identified morphine as the only opioid significantly associated with increased all-cause mortality at 30 days (HR 2.693 [95%CI 2.144-3.383], p < 0.001), 90 days (HR 2.151 [95%CI 1.757-2.632], p < 0.001), and 365 days (HR 1.709 [95%CI 1.435-2.036], p < 0.001). Furthermore, feature selection using the Boruta algorithm and SHAP summary plot highlighted opioid use, particularly morphine, as a key determinant of cumulative mortality.
Opioid use was a significant predictor of mortality in critically ill AMI patients. Notably, only morphine was independently associated with an increased risk of both short- and long-term mortality.
阿片类药物是重症急性心肌梗死（AMI）患者最常用的处方镇痛药。不幸的是，研究结果不一致且证据有限，这使得医疗保健提供者不确定这些药物是带来更多益处还是危害。因此，本研究旨在评估在重症监护病房住院的AMI患者中使用阿片类药物的影响。
从MIMIC-IV数据库中提取了总共5669例重症AMI患者的数据。其中，4044例患者接受了阿片类镇痛药治疗，而1625例患者未接受。主要结局是不同类型阿片类药物与30天、90天和365天全因死亡率之间的关联。在随访期间，接受阿片类药物治疗的患者死亡率显著高于未接受治疗的患者（30天：20.3%对10.1%；90天：28.0%对15.8%；365天：35.2%对26.4%；所有p<0.001）。在倾向得分匹配后，多变量Cox回归分析确定吗啡是唯一与30天（HR 2.693[95%CI 2.144-3.383]，p<0.001）、90天（HR 2.151[95%CI 1.757-2.632]，p<0.001）和365天（HR 1.709[95%CI 1.435-2.036]，p<0.001）全因死亡率增加显著相关的阿片类药物。此外，使用Boruta算法和SHAP汇总图进行的特征选择突出了阿片类药物的使用，尤其是吗啡，是累积死亡率的关键决定因素。
在重症AMI患者中，使用阿片类药物是死亡率的重要预测因素。值得注意的是，只有吗啡与短期和长期死亡风险增加独立相关。
