Supplementary File 1. One-year survival according to pre-hospital morphine use in propensity
score matched populations.
Supplementary Table 1. Propensity-score-matched cohorts.
Pre-hospital
No pre-hospital
Absolute
morphine use
morphine use
standardized
(n=388)
(n=388)
difference
59.7 ± 13.0
60.0 ± 13.2
0.0229
75 (19)
74 (19)
0.0065
26.9 ± 4.2
26.7 ± 4.3
0.0471
N=379
N=383
Hypertension
151 (39)
154 (40)
0.0158
Diabetes mellitus
49 (13)
46 (12)
0.0236
Current smoking
201 (52)
198 (51)
0.0155
Dyslipidemia
153 (39)
153 (39)
0
Myocardial infarction
40 (10)
40 (10)
0
Percutaneous coronary
42 (11)
43 (11)
0.0083
Coronary artery bypass grafting
19 (5)
22 (6)
0.0346
Heart failure
5 (1.5)
5 (1.5)
0
Stroke
9 (2.3)
14 (3.5)
0.0760
Peripheral artery disease
16 (4.1)
16 (4.1)
0
Chronic renal failure
6 (1.5)
7 (1.8)
0.0201
History of cancer
30 (8)
28 (7)
0.0196
Chronic obstructive lung disease
23 (6)
20 (5)
0.0338
Age, mean ± SD, y
Female, n (%)
Body mass index, mean ± SD,
kg/m²
Risk factors, n (%)
Previous medical history, n (%)
intervention
GRACE score, mean ± SD
137 ± 31
138 ± 30
0.0328
N=3
N=374
Aspirin before admission, n (%)
58 (15)
60 (15.5)
0.0144
Clopidogrel before admission, n (%)
22 (6)
20 (5)
0.0228
Beta-blockers before admission, n
62 (16)
54 (14)
0.0578
Statins before admission, n (%)
89 (23)
86 (22)
0.0185
ACE-inhibitors or ARB before
79 (20)
78 (20)
0.0064
130 (33)
112 (28)
0.1003
117 ± 122
124 ± 122
0.0574
Direct call to EMS, n (%)
250 (64)
244 (63)
0.0321
Pre-hospital fibrinolysis, n (%)
77 (20)
72 (19)
0.0327
Pre-hospital clopidogrel, n (%)
282 (73)
283 (73)
0.0058
Pre-hospital prasugrel, n (%)
71 (18)
72 (19)
0.0066
GP IIb/IIIa, n (%)
30 (8)
36 (9)
0.0555
110 (28)
116 (30)
0.0340
-14.0 ± 27.8
-10.5 ± 27.3
0.1270
-3.7 ± 18.9
-1.1 ± 17.7
0.1420
140 (40)
157 (46)
0.0902
7 (1.8)
4 (1.0)
0.0654
(%)
admission, n (%)
Visual analogue scale >7, n (%)
Time from symptom onset to ECG
(minutes)
Pre-hospital nitrates, n (%)
Change in systolic blood pressure
from first contact to admission
(mm Hg)
Change in heart rate from first
contact to admission (bpm)
TIMI 2/3 flow, n (%)
Recurrent infarction, n (%)
Stent thrombosis, n (%)
4 (1.0)
4 (1.0)
0
In-hospital death, n (%)
4 (1.0)
6 (1.5)
0.0457
ACE, angiotensin-converting enzyme; ARB, angiotensin-receptor blocker; GRACE, Global Registry of
Acute Coronary Events
Supplementary Table 2. Baseline parameters and reperfusion therapy according to pre-hospital use
of morphine in patients receiving pre-hospital thienopyridines.
Pre-hospital use of
No pre-hospital use of
P
morphine
morphine
value
(n=415)
(n=693)
59.2 ± 12.8
63.8 ± 13.9
<0.001
Age ≥ 75y, n (%)
59 (14)
178 (26)
<0.001
Female, n (%)
79 (19)
166 (24)
0.06
136 ± 31
143 ± 31
<0.001
Age, mean ± SD, y
GRACE score, mean ± SD
Reperfusion therapy, n (%)
-
None
-
<0.001
6 (1.5)
61 (9)
Fibrinolysis
100 (24)
100 (15)
Intended primary PCI
305 (74)
510 (76)
51 ± 10
51 ± 11
Left ventricular ejection fraction,
mean ± SD
GRACE, Global Registry of Acute Coronary Events; PCI, percutaneous coronary intervention
0.33
Supplementary Table 3. In-hospital complications according to pre-hospital use of morphine in
patients receiving pre-hospital thienopyridines.
In-hospital death, n
Pre-hospital
No pre-
OR
P value
use of
hospital use
(95% confidence
Crude
morphine
of morphine
interval)
(adjusted)
4 (1.0)
19 (2.7)
(%)
Recurrent MI, n (%)
0.045
0.28 (0.06-1.22)
8 (1.9)
7 (1.0)
0.20
1.35 (0.43-4.21)
Death or MI, n (%)
12 (2.9)
25 (3.6)
1 (0.2)
5 (0.7)
4 (1.0)
19 (2.7)
(0.64)
0.045
0.43 (0.14-1.30)
MI, myocardial infarction
(0.76)
0.29
0.57 (0.05-5.93)
Major bleeding, n (%)
(0.61)
0.52
0.88 (0.38-2.01)
Stroke, n (%)
(0.09)
(0.14)
Supplementary Table 4. FAST-MI 2005 replication cohort. Baseline characteristics according to prehospital use of morphine.
Pre-hospital use of
No pre-hospital use of
P
morphine
morphine
value
(n=279)
(n=1,447)
60.4 ± 13.6
65.9 ± 15.0
<0.001
Age ≥ 75y, n (%)
52 (19)
476 (33)
<0.001
Female, n (%)
66 (24)
450 (31)
0.01
27.2 ± 4.4
26.8 ± 4.8
0.32
Hypertension
122 (44)
758 (52)
0.008
Diabetes mellitus
33 (12)
312 (22)
<0.001
Current smoking
122 (44)
492 (34)
0.002
Dyslipidemia *
133 (48)
621 (43)
0.14
Myocardial infarction
27 (10)
190 (13)
0.11
Percutaneous coronary intervention
24 (9)
137 (9.5)
0.65
Coronary artery bypass grafting
4 (1)
42 (3)
0.16
Heart failure
7 (2.5)
72 (5)
0.07
Stroke
7 (2.5)
67 (5)
0.11
Peripheral artery disease
12 (4)
96 (7)
0.14
Chronic renal failure
6 (2)
59 (4)
0.12
Chronic obstructive lung disease
9 (3)
45 (3)
0.92
History of cancer
11 (4)
98 (7)
0.08
Age, mean ± SD, y
Body mass index, mean ± SD, kg/m²
Risk factors, n (%)
Previous medical history, n (%)
GRACE score, mean ± SD
143 ± 33
152 ± 36
<0.001
Left ventricular ejection fraction,
52 ± 12
51 ± 13
0.11
47 (17)
274 (19)
0.41
Clopidogrel
19 (7)
132 (9)
0.21
Beta-blockers
47 (17)
265 (20)
0.27
Statins
60 (21.5)
323 (22)
0.76
ACE-inhibitors or ARB
59 (21)
403 (28)
0.02
Pre-hospital LMWH
71 (25)
148 (10)
<0.001
Pre-hospital clopidogrel
63 (23)
146 (10)
<0.001
mean ± SD
Previous medications, n (%)
Aspirin
Management, n (%)
Reperfusion therapy
*
-
None
-
<0.001
26 (9)
627 (43)
Fibrinolysis
134 (49)
332 (23)
Intended primary PCI
119 (43)
487 (34)
Included patients with previously documented diagnosis of hypercholesterolemia be treated with
diet or medication or new diagnosis made during this hospitalization with elevated total cholesterol
>160 mg/dl; did not include elevated triglycerides.
ACE, angiotensin-converting enzyme; ARB, angiotensin-receptor blocker; GRACE, Global Registry of
Acute Coronary Events; LMWH, low molecular weight heparin; PCI, percutaneous coronary
intervention
Supplementary Table 5. FAST-MI 2005 replication cohort. In-hospital complications according to
pre-hospital use of morphine.
Pre-hospital
No pre-
P value
morphine use
hospital
Adjusted Odds ratio
Crude
(n=279)
morphine use
(95% CI)
(adjusted)
(n=1,447)
Death, n (%)
10 (3.6)
103 (7.1)
0.03
0.48 (0.21-1.10)
Recurrent-MI, n
3 (1.1)
23 (1.6)
(%)
(0.08)
0.52
0.75 (0.21-2.66)
(0.65)
In-hospital
death or
12 (4.3)
118 (8.2)
recurrent MI, n
0.03
0.59 (0.29-1.23)
(0.16)
(%)
Stroke, n (%)
3 (1.1)
16 (1.1)
0.98
1.69 (0.46-6.26)
TIMI major
bleeding, n (%)
3 (1.1)
30 (2.1)
(0.43)
0.27
0.59 (0.17-2.03)
MI, myocardial infarction; TIMI, thrombolysis in myocardial infarction
(0.40)
Supplementary Table 6. FAST-MI 2005 registry. Main baseline characteristics and in-hospital
outcomes in patients receiving pre-hospital clopidogrel.
Pre-hospital use of
No pre-hospital use of
P
morphine
morphine
value
(n=63)
(n=146)
58.4 ± 12.4
63.2 ± 14.3
0.02
Age ≥ 75y, n (%)
7 (11)
37 (25)
0.02
Female, n (%)
66 (24)
450 (31)
0.01
136 ± 30
148 ± 32
0.015
Age, mean ± SD, y
GRACE score, mean ± SD
Reperfusion therapy, n (%)
0.01
-
None
7 (11)
35 (24)
-
Fibrinolysis
32 (51)
45 (31)
-
Intended primary PCI
24 (38)
66 (45)
51 ± 12
51 ± 13
0.94
0
6 (4.1)
0.10
Recurrent MI
1 (1.6)
0
0.13
Death or MI
1 (1.6)
6 (4.1)
0.35
Stroke
0
0
TIMI major bleeding
0
2 (1.4)
Left ventricular ejection fraction,
mean ± SD
In-hospital complications, n (%)
In-hospital death
GRACE, Global Registry of Acute Coronary Events; PCI, percutaneous coronary intervention; MI,
myocardial infarction; TIMI, thrombolysis in myocardial infarction
0.35