Chest
Volume 144, Issue 3, September 2013, Pages 750-757
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Original Research
COPD
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Impact of COPD on Long-term Outcome After ST-Segment Elevation Myocardial Infarction Receiving Primary Percutaneous Coronary Intervention

https://doi.org/10.1378/chest.12-2313Get rights and content

Background

There are limited data describing the long-term outcome of patients with concomitant COPD who develop ST-segment elevation myocardial infarction (STEMI).

Methods

A total of 11,118 consecutive patients with STEMI enrolled in the web-based Registro Regionale Angioplastiche Emilia-Romagna (REAL) registry were followed-up and stratified according to COPD presence or not. At 3-year follow-up, mortality and hospital readmissions due to myocardial infarction (MI), heart failure (HF), coronary revascularization (CR), serious bleeding, and COPD were assessed.

Results

According to our criteria, 2,032 patients (18.2%) had a diagnosis of COPD. Overall, 1,829 patients (16.5%) died. COPD was an independent predictor of mortality (hazard ratio [HR], 1.4; 95% CI, 1.2-1.6). Hospital readmissions for recurrent MI (10% vs 6.9%, P < .01), CR (22% vs 19%, P < .01), HF (10% vs 6.9%, P < .01), and SB (10% vs 6%, P < .01) were significantly more frequent in patients with COPD as compared with those without. Also, hospital readmissions for COPD were more frequent in patients with a previous history of COPD as compared with those without (19% vs 3%; P < .01, respectively). Patients with a hospital readmission for COPD showed a fourfold increased risk of death (HR, 4.2; 95% CI, 3.4-5.2). Finally, hospital readmissions for COPD emerged as a strong independent risk factor for recurrence of MI (HR, 2.1; 95% CI, 1.4-3.3), HF (HR, 5.8; 95% CI, 4.6-7.5), and SB (HR, 3; 95% CI, 2.1-4.4).

Conclusions

Patients with STEMI and concomitant COPD are at greater risk for death and hospital readmissions due to cardiovascular causes (eg, recurrent MI, HF, bleedings) than patients without COPD.

Section snippets

Study Design

The REAL registry was previously described.8, 9, 10 Briefly, it is a large, prospective, worldwide, web-based registry launched in July 2002 and designed to collect clinical and angiographic data on all consecutive PCIs performed in a 4-million-resident region of Italy. The registry is ongoing. Thirteen public and private centers of interventional cardiology participate in the data collection. Procedural data are retrieved directly and continuously from the resident databases of each

Results

As shown in Table 1, the study population of the present analysis was of 11,118 patients. According to our criteria, 2,032 patients (18.2%) had a diagnosis of COPD before hospital admission for STEMI. Overall, the average age was 66 years, and 72% were men. Compared with patients without COPD, patients with COPD were 5 years older and more likely to have had hypertension, renal disease, coronary artery disease, and bleeding event previously diagnosed (Table 1). As expected, smoking habits

Discussion

The results of this large observational multicenter study among residents of Emilia-Romagna, an Italian region, hospitalized with STEMI and treated with primary PCI demonstrated significant differences among patients with and without concomitant COPD with regard to clinical presentation, treatments received, and long-term outcomes. Patients with COPD were more likely to have pulmonary edema at entry; were less likely to receive glycoprotein IIb/IIIa inhibitors, drug-eluting stents, and

Conclusions

COPD is a frequent comorbidity in patients admitted to the hospital for STEMI. Our analysis showed that, in spite of recent progress in the treatment of cardiac and pulmonary diseases, STEMI patients with concomitant COPD are at increased risk for death and hospital readmissions as compared with those without COPD as comorbidity.

Acknowledgments

Author contributions: Drs Campo and Saia and Mr Guastaroba are the guarantors of the paper, taking responsibility for the integrity of the work as a whole, from inception to published article.

Dr Campo: contributed to conception and design, acquisition of data, analysis and interpretation of data, drafting the submitted article, and revising it critically for important intellectual content.

Mr Guastaroba: contributed to conception and design, acquisition of data, and analysis and interpretation

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For editorial comment see page 723

Funding/Support: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

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