In this observational prospective multicentre study that enrolled 2481 patients, the authors tried to highlight the relationship between chronic obstructive pulmonary disease (COPD) and a number of outcomes following an acute myocardial infarction (MI).

One-year mortality and rehospitalisation rates were significantly higher in patients with COPD than without (15.8% vs 5.7%) and (48.7% vs 38.6%), respectively. In addition, patients with COPD had worse health status at baseline as well as at 1 year and a trend toward a higher prevalence of angina at 1 year. Not surprisingly, patients with COPD had fewer coronary revascularisation procedures and less use of β blockers, aspirin and cardiac rehabilitation.

With the well-documented role of β blockers in improving survival post-MI even in patients with COPD, it is possible that more frequent usage of these agents, particularly the cardio-selective agents, in the study population could have led to a better 1 year survival than observed and possibly a lower prevalence of angina, again at 1 year.

The study used clinical rather than pulmonary function test definition of COPD and as a consequence could have misclassified some patients with possible inclusion of non-COPD patients, for example those with asthma. Furthermore, the outcomes could have been influenced by the severity of COPD, which the authors were unable to classify. Nevertheless, the data suggest that patients with acute MI and COPD have a substantially worse prognosis in terms of mortality and health status. This cohort of patients therefore warrants careful attention and closer follow-up.