Clinical Investigation
Acute Ischemic Heart Disease
Association of chronic lung disease with treatments and outcomes patients with acute myocardial infarction

https://doi.org/10.1016/j.ahj.2012.09.010Get rights and content

Background

Although chronic lung disease (CLD) is common among patients with myocardial infarction (MI), little is known about the influence of CLD on patient management and outcomes following MI.

Methods

Using the National Cardiovascular Data Registry's ACTION Registry-GWTG, demographics, clinical characteristics, treatments, processes of care, and in-hospital adverse events after acute MI were compared between patients with (n = 22,624) and without (n = 136,266) CLD. Multivariable adjustment was performed to determine the independent association of CLD with treatments and adverse events.

Results

CLD (17.0% of non–ST-elevation MI [NSTEMI] and 10.1% of ST-elevation MI [STEMI] patients) was associated with older age, female sex, and a greater burden of comorbidities. Among NSTEMI patients, those with CLD were less likely to undergo cardiac catheterization, percutaneous coronary intervention, and coronary artery bypass graft compared to those without; in contrast, no differences were seen in invasive therapies for STEMI patients with or without CLD. Multivariable-adjusted risk of major bleeding was significantly increased in CLD patients with NSTEMI (13.0% vs 8.1%, ORadj = 1.27, 95% CI = 1.20-1.34, P < .001) and STEMI (16.0% vs 10.5%, ORadj = 1.19, 95% CI = 1.10-1.29, P < .001). In NSTEMI, CLD was associated with a higher risk of inhospital mortality (ORadj = 1.21, 95% CI = 1.11-1.33); in STEMI no association between CLD and mortality was seen (ORadj = 1.05, 95% CI = 0.95-1.17).

Conclusions

CLD is common among patients with MI and is independently associated with an increased risk for major bleeding. In NSTEMI, CLD is also associated with receiving less revascularization and with increased in-hospital mortality. Special attention should be given to this high-risk subgroup for the prevention and management of complications after MI.

Section snippets

Study population

The ACTION Registry-GWTG (AR-G) is one of the nation's largest databases of patients hospitalized with MI. We studied all 183,704 patients who were enrolled in the ACTION registry between January 1, 2008, and December 31, 2010. We excluded 16,877 patients due to incomplete data and 7,937 due to inter-hospital transfer after initial presentation. Therefore, the present analyses are based upon 158,890 patients at 445 participating sites.

Data collection and definitions

Trained data collectors at each participating center

Results

Of 158,890 patients with acute MI, 22,624 (14.2%) had CLD. Characteristics of those with and without CLD are presented in Table I. Compared to those without CLD, patients with CLD were older, more likely to be female, white, recent smokers, and had higher rates of cardiovascular comorbidities. They had longer delays to presentation, and were more likely to be using cardiac medications prior to presentation. Patients with CLD also had lower peak troponin and initial creatinine clearance, but

Discussion

In a large contemporary registry of patients with MI, we observed that CLD is present in approximately 15% of all MI patients and is associated with several important differences in treatments, processes of care, and outcomes compared to patients without CLD. CLD is independently associated with an increased risk of in-hospital mortality in the setting of NSTEMI, and with increased risk of major bleeding in both NSTEMI and STEMI. To our knowledge, this is the first study to describe an

Conclusions

Chronic lung disease is a common comorbidity, present in approximately 1 in 7 patients presenting with MI. CLD is independently associated with major bleeding after both NSTEMI and STEMI and special attention to clinical surveillance for bleeding events, selection and dosing of anticoagulant and antiplatelet therapies, and consideration of radial access during cardiac catheterization may be prudent in this high-risk subgroup for the prevention and management of bleeding complications. In

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    Michael P. Hudson, MD served as guest editor for this article.

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