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Inhaled corticosteroid/long-acting bronchodilator treatment mitigates STEMI clinical presentation in COPD patients
Marco Contoli1, Gianluca Campo2, Rita Pavasini3
1Research Centre on Asthma and COPD, Section of Internal and Cardio-Respiratory Medicine, University of Ferrara, Ferrara, Italy.
Insights
Inhaled corticosteroids/long-acting bronchodilator (ICS/LABD) treatment in patients with chronic obstructive pulmonary disease (COPD) and ST-segment elevation myocardial infarction (STEMI) reduced acute clinical severity and short-term mortality. Long-term mortality was not affected.
Area of Science:
- Cardiology
- Pulmonology
- Pharmacology
Background:
- Patients with myocardial infarction (MI) and chronic obstructive pulmonary disease (COPD) face higher risks of adverse clinical outcomes, including mortality.
- COPD exacerbates the severity and prognosis of ST-segment elevation myocardial infarction (STEMI).
Purpose of the Study:
- To compare the clinical presentation severity and mortality rates (short- and long-term) in STEMI patients with COPD.
- To evaluate the impact of inhaled corticosteroids/long-acting bronchodilator (ICS/LABD) therapy versus other inhaled treatments on STEMI outcomes in COPD patients.
Main Methods:
- Analysis of data from the prospective REAL Registry, including 11,118 STEMI patients.
- Identification and comparison of 2032 COPD patients treated with ICS/LABD versus other inhaled regimens prior to STEMI admission.
Main Results:
- ICS/LABD treatment was associated with a reduced risk of pulmonary edema and cardiogenic shock in STEMI patients with COPD.
- ICS/LABD use was linked to significantly lower 7-day mortality (OR 0.54, 95%CI 0.29-0.98, p=0.045) compared to other inhaled treatments.
- No significant effect on long-term mortality (median 4 years) was observed. Use of ICS/LABD decreased post-discharge.
Conclusions:
- ICS/LABD treatment may reduce the acute-phase clinical severity of STEMI in patients with COPD.
- Preliminary evidence suggests a benefit of ICS/LABD in managing STEMI in the context of COPD, particularly for short-term outcomes.
Background:
Patients with myocardial infarction and concomitant COPD are at increased risk of poor clinical outcomes, including death, as compared to patients without COPD.
Aim:
To investigate and compare the severity of the clinical presentation of ST-segment elevation myocardial infarction (STEMI) and of the short-(7days) and long-term-(end of follow up) mortality in COPD patients treated with inhaled corticosteroids (ICS)/long-acting bronchodilator (LABD) - either long-acting beta2 agonist (LABA) or long-acting muscarinic antagonist (LAMA) - vs. any other inhaled treatments.
Methods:
Data from the REAL (Registro Angioplastiche dell'Emilia-Romagna) Registry were obtained from a large prospective study population of 11,118 patients admitted to hospital for STEMI.
Results:
From January 2003 to June 2009 we identified 2032 COPD patients admitted to hospital for STEMI. Eight hundred and twenty (40%) COPD patients were on ICS/LABD treatment (of which 55% on ICS/LABA) prior to admission. After adjustment for potential confounding factors, ICS/LABD treatment before STEMI was an independent predictor of reduced risk of pulmonary oedema and cardiogenic shock (OR 0.5, 95%CI 0.3-0.72, p<0.01; OR 0.7, 95%CI 0.4-0.9, p=0.03, respectively). ICS/LABD treatment was associated to reduced 7-days mortality (OR 0.54, 95%CI 0.29-0.98, p=0.045) compared to other inhaled regimens. ICS/LABD-treated did not affect long-term (median 4years) mortality. After hospital discharge, the proportion of ICS/LABD treated patients decreased significantly at 6months and afterwards after the STEMI episode.
Conclusion:
Our data provide preliminary evidence that in COPD patients ICS/LABD treatment reduces the severity of STEMI acute-phase clinical manifestations compared to other inhaled treatments.
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