Chronic lung disease (CLD)—including COPD, chronic bronchitis, and emphysema—is common, presenting in approximately one in seven patients presenting with myocardial infarction (MI). Patients with CLD are more likely to die or be hospitalized from cardiovascular disease than from any other disease. Despite this knowledge, few studies have explored the influence of CLD on patient management and outcomes following MI. Gaining a better understanding of this relationship could lead to opportunities for improving quality of care and outcomes for CLD patients.
Treatments & Mortality for Chronic Lung Disease
In a study published in the American Heart Journal, my colleagues and I utilized the National Cardiovascular Data Registry to determine the association of CLD with treatments and adverse events after MI. Our results showed that CLD patients presenting with non-STEMI had a 20% increased risk for in-hospital death when compared with those who did not have CLD. No such link, however, was found among CLD patients with STEMI.
In addition, CLD patients with non-STEMI were markedly less likely to receive invasive procedures, such as cardiac catheterization, PCI, or CABG surgery. They were also slightly less likely to receive evidence-based medical therapies, including thienopyridines, β-blockers, and statins. Conversely, differences in treatment of STEMI patients with CLD were not clinically significant, according to findings in our investigation.
Taking a Closer Look at Bleeding Risks
This is also the first study to our knowledge indicating that, independent of other factors, CLD patients had a 20% to 25% higher risk of bleeding when compared with those without CLD. Major bleeding is one of the most common in-hospital complications following acute coronary syndromes and is associated with worse outcomes, including death. Several factors may contribute to excess bleeding in patients with CLD, including underlying frailty and differences in medical treatments. There may also be pathophysiologic differences between those with and without CLD contributing to higher risk of bleeding.
In light of these results, we should continue to develop and apply better systems of care to reduce disparities and optimize outcomes for CLD patients who experience MI. Careful selection and dosing of anticoagulant and antiplatelet therapies and the use of radial access during cardiac catheterization should also be considered to reduce bleeding in this high-risk subgroup of patients.
Readings & Resources (click to view)
Enriquez JR, de Lemos JA, Parikh SV, et al. Association of chronic lung disease with treatments and outcomes patients with acute myocardial infarction. Am Heart J. 2013;165:43-49. Available at: http://www.ahjonline.com/article/S0002-8703(12)00653-9/fulltext.
Enriquez JR, Parikh SV, Selzer F, et al. Increased adverse events after percutaneous coronary intervention in patients with COPD: insights from the National Heart, Lung, and Blood Institute dynamic registry. Chest. 2011;140:604-610.
Salisbury AC, Reid KJ, Spertus JA. Impact of chronic obstructive pulmonary disease on post-myocardial infarction outcomes. Am J Cardiol. 2007;99:636-641.
Peterson ED, Roe MT, Chen AY, et al. The NCDR ACTION Registry-GWTG: transforming contemporary acute myocardial infarction clinical care. Heart. 2010;96:1798-1802.
Sin DD, Man SF. Why are patients with chronic obstructive pulmonary disease at increased risk of cardiovascular diseases? The potential role of systemic inflammation in chronic obstructive pulmonary disease. Circulation. 2003;107:1514-1519.