Several reports have alluded to the adverse effect of chronic obstructive pulmonary
disease (COPD) on long-term prognosis of patients with myocardial infarction (MI).
Little information is available, however, regarding the effects of a decrease in cardiopulmonary
reserve imposed by COPD on in-hospital outcome of acute MI. This study aimed to evaluate
the impact of COPD on acute-phase outcome of patients with acute MI. From a cohort
of 3,249 consecutive patients with ST-elevation MI who underwent primary or rescue
percutaneous coronary intervention, 365 patients were identified as having coexistent
COPD. Their clinical presentation and in-hospital outcome were compared to those of
2,884 patients without COPD. The primary end point was a composite of in-hospital
death or cardiogenic shock on presentation. Patients with COPD were older (p <0.001),
more often women (p <0.001), and smokers (p <0.001). They had higher prevalence of
chronic renal insufficiency (p <0.001), systemic hypertension (p = 0.001), and diabetes
mellitus (p = 0.01). Patients with COPD had higher rates of the composite end point
of death or cardiogenic shock (p <0.0001). After multivariate analysis, COPD remained
a strong independent predictor of the composite end point of death or cardiogenic
shock (p = 0.008). In conclusion, COPD is a very strong predictor of hemodynamic compromise
resulting in death or cardiogenic shock in patients presenting with ST-elevation MI.
This observation suggests that hemodynamic and pulmonary consequences of COPD decrease
the capacity of the circulatory system to adjust to the effects of acute MI. Recognition
of the potential for combined therapy is vital.
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Article info
Publication history
Published online: June 21, 2010
Accepted:
March 4,
2010
Received in revised form:
March 4,
2010
Received:
January 22,
2010
Identification
Copyright
© 2010 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
