The prognostic role of chronic obstructive pulmonary disease in ST-elevation myocardial infarction after primary angioplasty

Abstract

Chronic obstructive pulmonary disease (COPD) has been reported as a common finding in patients with acute myocardial infarction but data on its prognostic role are still controversial. The present investigation was aimed at assessing the impact of COPD at short and long terms in 818 consecutive patients with ST-elevation myocardial infarction all submitted to percutaneous coronary intervention. Patients with COPD were older (p < 0.001) and more frequently smokers (p = 0.019). They showed a reduced estimated glomerular filtration rate (eGFR; p = 0.004) and a higher incidence of a more advanced coronary artery disease (p = 0.004). Patients with COPD showed higher values of N-terminal pro-brain natriuretic peptide (p = 0.004), uric acid (p = 0.005), erythrocyte sedimentation rate (p = 0.002), fibrinogen (p = 0.004), and C-reactive protein positivity (p = 0.017). Kaplan-Meier survival curve documented a significantly worse outcome in COPD patients. When age was taken into account, COPD patients aged <75 years showed a significantly worse outcome at follow up when compared to non-COPD patients aged <75 years. At multivariate analysis, the following variables were independent predictors for death at follow up: age, eGFR, COPD, and discharge left ventricular ejection fraction. In our series, while the presence of COPD was not significantly associated with an increased early mortality, COPD is an independent predictor of long-term mortality. In particular, long-term survival was significantly poorer in COPD patients <75 years in respect to non-COPD patients with the same age. Our data strongly suggest that age should be taken into account in the risk stratification of COPD patients with ST-elevation myocardial infarction.