Clinical InvestigationAcute Ischemic Heart DiseaseAssociation of chronic lung disease with treatments and outcomes patients with acute myocardial infarction
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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2017, International Journal of CardiologyCitation Excerpt :However, those studies included all STEMI patients that underwent mechanical reperfusion. Since COPD patients have been shown to present more often left bundle branch block [17] and a history of coronary artery bypass surgery [8] than patients without COPD, and because they also tend to present later and have delayed diagnosis of STEMI [18], the differences in inclusion criteria may explain, at least partially, the lower COPD prevalence in our study. Large-scale clinical studies have demonstrated that COPD not only increases the risk of myocardial infarction, but is also associated with poorer long-term outcomes following myocardial infarction [5–7,10].
Effect of Chronic Obstructive Pulmonary Disease on In-Hospital Mortality and Clinical Outcomes After ST-Segment Elevation Myocardial Infarction
2017, American Journal of CardiologyCitation Excerpt :In contrast, other smaller sample studies by Sung et al12 and Lazzeri et al13 reported no significant in-hospital mortality difference in STEMI patients with and without COPD. In a large registry-based study comparing 6,395 STEMI patients with COPD and 56,911 STEMI patients without COPD, a higher unadjusted rate of death (9.2% vs 5.5%) was found, but no difference in risk-adjusted mortality (AOR 1.05, 95% CI 0.95 to 1.17) was noted.11 Still, the AOR for mortality in that study is similar to our study (1.05 vs 1.13); thus, the failure to find a significant difference in the former studies may have been due to lower statistical power from a smaller sample size.11–13
Low forced expiratory volume in one second is associated with the history of acute coronary syndrome in patients with organic coronary stenosis
2017, Journal of CardiologyCitation Excerpt :Reduced forced expiratory volume in one second (FEV1.0) has been known to be a risk of cardiovascular death [6–8]. From the viewpoint of coronary artery disease (CAD), coexistent COPD has a negative impact on acute-phase and long-term prognosis [9–13]. Although COPD and CAD share some risk factors such as smoking habits, advanced age, sedentary life style, and male sex, it cannot fully explain the high incidence of cardiovascular events in COPD [6].
Treatment and outcomes of patients with chronic lung disease and acute myocardial infarction: Insights from the nationwide AMIS plus registry
2024, European Journal of Clinical Investigation
Michael P. Hudson, MD served as guest editor for this article.