Coronary artery disease
Impact of Chronic Obstructive Pulmonary Disease on Post-Myocardial Infarction Outcomes

https://doi.org/10.1016/j.amjcard.2006.09.112Get rights and content

Although chronic obstructive pulmonary disease (COPD) is common in patients with myocardial infarction (MI), its association with long-term mortality after MI is controversial and little is known about its influence on patients’ health status (symptoms, function, and quality of life). We prospectively enrolled 2,481 patients presenting with MI at 19 United States centers to examine the relations between COPD and patients’ long-term mortality, rehospitalization rates, and health status after MI. Patients were administered the disease-specific Seattle Angina Questionnaire and the generic Short Form 12 at baseline and 1 year later. COPD was common (15.6% of patients) and was associated with a substantially greater risk of 1-year mortality (15.8% vs 5.7%, p <0.001) and rehospitalization (48.7% vs 38.6%, p <0.001). After extensive adjustment for baseline differences, patients with COPD had a twofold greater 1-year mortality rate (hazard ratio 2.00, 95% confidence interval [CI] 1.44 to 2.79) and higher rehospitalization rates (hazard ratio 1.22, 95% CI 1.01 to 1.48). Similarly, adjusted 1-year health status was worse in patients with COPD, with lower 1-year Seattle Angina Questionnaire quality-of-life score (−2.53 points, 95% CI −0.25 to −4.81) and Short Form 12 physical component score (−1.83 points, 95% CI −0.43 to −3.24). In addition, COPD was associated with a trend toward a greater prevalence of angina at 1 year (risk ratio 1.12, 95% CI 0.89 to 1.41). In conclusion, patients with COPD have greater mortality, higher rehospitalization rates, and poorer health status 1 year after a MI. Although additional research is needed, clinicians should recognize that patients with COPD are at high risk for poor outcomes after MI.

Section snippets

Study population

Data were collected from patients enrolled in a prospective, observational study of outcomes after MI between January 1, 2003 and June 28, 2004 at 19 centers across the United States (Appendix) for the Prospective Registry Evaluating Myocardial Infarction: Event and Recovery (PREMIER) study. Details of patient recruitment and enrollment have been previously described.10 In total, 2,498 patients provided informed consent and were enrolled. All patients were ≥18 years of age, had an increased

Results

Of 2,481 patients after MI, 387 (15.6%) had a history of COPD. Baseline sociodemographic, economic, co-morbid, disease severity, and treatment characteristics of those with and without COPD are presented in Table 1.

Discussion

We found that COPD was present in almost 1 of 6 patients with MI and was associated with important treatment differences, including fewer coronary revascularization procedures and less use of β blockers, aspirin, and cardiac rehabilitation. Our study is the first to provide insight into the role of COPD after MI in patients’ health status; notably, our data indicate that patients with COPD have worse quality of life and physical functioning and trend toward a greater prevalence of angina 1 year

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    This project was principally supported by CV Therapeutics, Inc., Palo Alto, California.

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