Impact of COPD on long-term outcome after ST-segment elevation myocardial infarction receiving primary percutaneous
Gianluca Campo1, Paolo Guastaroba2, Antonio Marzocchi3
1Cardiovascular Institute, Azienda Ospedaliero-Universitaria S.Anna, Ferrara; LTTA center, Ferrara.
Insights
Patients with ST-segment elevation myocardial infarction (STEMI) and chronic obstructive pulmonary disease (COPD) face higher mortality and readmission risks. COPD exacerbations significantly increase the risk of death, recurrent heart attack, heart failure, and bleeding.
Area of Science:
- Cardiology
- Pulmonology
- Public Health
Background:
- Limited data exist on the long-term outcomes for patients experiencing ST-segment elevation myocardial infarction (STEMI) with co-existing chronic obstructive pulmonary disease (COPD).
- Understanding these outcomes is crucial for improving patient care and management strategies.
Purpose of the Study:
- To evaluate the long-term prognosis of patients with STEMI and concomitant COPD.
- To assess the impact of COPD on mortality and hospital readmissions following STEMI.
Main Methods:
- A cohort of 11,118 STEMI patients from the REAL registry were followed for 3 years.
- Patients were stratified based on the presence or absence of COPD.
- Outcomes assessed included mortality and hospital readmissions for myocardial infarction (MI), heart failure (HF), coronary revascularization (CR), serious bleeding (SB), and COPD.
Main Results:
- 18.2% of patients had COPD. COPD was an independent predictor of mortality (HR, 1.4).
- Patients with COPD had significantly higher readmission rates for recurrent MI, CR, HF, and SB.
- COPD readmissions were frequent (19% vs 3%) and strongly predicted death (HR, 4.2), recurrent MI (HR, 2.1), HF (HR, 5.8), and SB (HR, 3).
Conclusions:
- Patients with STEMI and COPD face elevated risks of death and cardiovascular-related hospital readmissions compared to those without COPD.
- COPD exacerbations are a significant independent risk factor for adverse outcomes, including mortality, recurrent MI, HF, and serious bleeding.
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.
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