The prognostic role of chronic obstructive pulmonary disease in ST-elevation myocardial infarction after primary angioplasty

Abstract

Background: Chronic obstructive pulmonary disease (COPD) has been reported as a common finding in patients with acute myocardial infarction but data on its prognostic role are still controversial. Methods: The present investigation was aimed at assessing the impact of COPD at short and long terms in 818 consecutive patients with ST-elevation myocardial infarction all submitted to percutaneous coronary intervention. Results: Patients with COPD were older (p<0.001) and more frequently smokers (p=0.019). They showed a reduced estimated glomerular filtration rate (eGFR; p=0.004) and a higher incidence of a more advanced coronary artery disease (p=0.004). Patients with COPD showed higher values of N-terminal pro-brain natriuretic peptide (p=0.004), uric acid (p=0.005), erythrocyte sedimentation rate (p=0.002), fibrinogen (p=0.004), and C-reactive protein positivity (p=0.017). Kaplan-Meier survival curve documented a significantly worse outcome in COPD patients. When age was taken into account, COPD patients aged <75 years showed a significantly worse outcome at follow up when compared to non-COPD patients aged <75 years. At multivariate analysis, the following variables were independent predictors for death at follow up: age, eGFR, COPD, and discharge left ventricular ejection fraction. Conclusions: In our series, while the presence of COPD was not significantly associated with an increased early mortality, COPD is an independent predictor of long-term mortality. In particular, long-term survival was significantly poorer in COPD patients <75 years in respect to non-COPD patients with the same age. Our data strongly suggest that age should be taken into account in the risk stratification of COPD patients with ST-elevation myocardial infarction. © The European Society of Cardiology 2012.