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. 2014 Feb 3;1(1):e000002.
doi: 10.1136/openhrt-2013-000002. eCollection 2014.

Impact of chronic obstructive pulmonary disease on morbidity and mortality after myocardial infarction

Pontus Andell  1 , Sasha Koul  1 , Andreas Martinsson  1 , Johan Sundström  2 , Tomas Jernberg  3 , J Gustav Smith  1 , Stefan James  2 , Bertil Lindahl  2 , David Erlinge  1
Affiliations

Impact of chronic obstructive pulmonary disease on morbidity and mortality after myocardial infarction

Pontus Andell et al. Open Heart. .

Abstract

Aim: To gain a better understanding of the impact of chronic obstructive pulmonary disease (COPD) on long-term mortality in patients with myocardial infarction (MI) and identify areas where the clinical care for these patients may be improved.

Methods: Patients hospitalised for MI between 2005 and 2010 were identified from the nationwide Swedish SWEDEHEART registry. Patients with MI and a prior COPD hospital discharge diagnosis were compared to patients with MI without a prior COPD hospital discharge diagnosis for the primary endpoint of all-cause mortality at 1 year after MI. Secondary endpoints included rates of reinfarction, new-onset stroke, new-onset bleeding and new-onset heart failure at 1 year.

Results: A total of 81 191 MI patients were included, of which 4867 (6%) had a COPD hospital discharge diagnosis at baseline. Patients with COPD showed a significantly higher unadjusted 1-year mortality (24.6 vs 13.8%) as well as a higher rate of reinfarction, new-onset bleeding and new-onset heart failure post-MI. After adjustment for potential confounders, including comorbidities and treatment, the patients with COPD still showed a significantly higher 1-year mortality (HR 1.14, 95% CI 1.07 to 1.21) as well as a higher rate of new-onset heart failure (HR 1.35, 95% CI 1.24 to 1.47), whereas no significant association between COPD and myocardial reinfarction or new-onset bleeding remained.

Conclusions: In this nationwide contemporary study, patients with COPD frequently had an atypical presentation, less often underwent revascularisation and less often received guideline-recommended secondary preventive medications of established benefit. Prior COPD was associated with a higher 1-year mortality and a higher risk of subsequent new-onset heart failure after MI. The association seems to be mainly explained by differences in background characteristics, comorbidities and treatment, although a minor part might be explained by COPD in itself. Improved in-hospital MI treatment and post-MI secondary prevention according to the guidelines may lower the mortality in this high-risk population.

Keywords: Coronary Artery Disease; Heart Failure.

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Figures

Figure 1
Figure 1
A Kaplan-Meier plot showing the crude 1-year mortality for patients with chronic obstructive pulmonary disease (COPD) versus patients without COPD.
See this image and copyright information in PMC

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