Impact of chronic obstructive pulmonary disease in patients with myocardial infarction

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Chronic obstructive pulmonary disease (CPOD) is a common comorbidity in patients admitted with myocardial infarction (MI) and needs to be considered since it can condition therapeutic approach and potentially negatively impact their prognosis. Purpose We aim to evaluate the impact of CPOD in therapeutic approach, clinical course and in-hospital mortality in patients admitted with MI. Methods We retrospectively analysed a population of 2797 patients admitted with MI (C). We divided them into two distinct groups: those with an established diagnosis of CPOD (C1) and those without it (C2). Age, sex, personal history, in-hospital therapeutic, left ventricular ejection fraction (LVEF), electrocardiographical presentation and angioplasty were documented. We defined the following as complications: heart failure (HF), need for invasive and non-invasive mechanical ventilation, reinfarction, newly onset atrial fibrillation, high-grade atrioventricular block and need for temporary cardiac pacing. Mortality, incidence of complications and a combined outcome of both mortality and any of the previous complications were compared between groups. We applied a multivariate analysis to adjust the effect of CPOD to the presence of other potential predictors. Results C1 consisted of 6,3% of the population (N=173). These patients were older (69,8±10,6 vs 65,5±13,5 years; p<0,001), had a higher prevalence of hypertension (76,3% vs 68,7%; p=0,036) and chronic kidney disease (13,7% vs 5,6%; p<0,001). They presented less frequently with ST-segment elevation MI (38,3 % vs 47,4%; p=0,019), but more often with depressed LVEF (57,9% vs 47,2%, p=0,008). They received less beta-blockers (63,4% vs 80,2%; p<0,001) and had fewer rates of drug-eluting stents application (63,4% vs 80,2%; p<0,001); on the other hand, they were more frequently medicated with calcium-channel blockers (16,7% vs 8,1%; p<0,001) and diuretics (50,0% vs 31,6%; p<0,001) and more bare-metal stents were utilised (52,8% vs 37,4%; p=0,002). The diagnosis of CPOD was not associated with higher mortality in patients with MI, however C1 presented with an increased incidence of complications (33,1% vs 26,0%; OR =1,413 [1,019-1,959]; p=0,037) and of the combined outcome (34,3% vs 26,5%; OR=1,447 [1,046-2,000]; p=0,02). Though multivariate analysis, CPOD tends to be an independent predictor of mortality and/or development of complications, although it narrowly misses to achieve statistical significance (p=0,056); only age, medication with beta-blockers and depressed LVEF were statistically independent predictors. Conclusions The comorbid diagnosis of CPOD conditions the choice of medication in patients with MI and tends to be an independent predictor of mortality and/or development of in-hospital complications.