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Original Research: CARDIOVASCULAR DISEASE |

The Impact of COPD on Management and Outcomes of Patients Hospitalized With Acute Myocardial InfarctionAcute Myocardial Infarction and COPD: A 10-Year Retrospective Observational Study

Mihaela S. Stefan, MD; Raveendhara R. Bannuru, MD; Darleen Lessard, MS; Joel M. Gore, MD; Peter K. Lindenauer, MD; Robert J. Goldberg, PhD
Author and Funding Information

From the Department of General Medicine (Drs Stefan and Lindenauer), Baystate Medical Center, Springfield, MA; the Tufts Clinical and Translational Science Institute (Drs Stefan, Bannuru, and Lindenauer), Tufts University School of Medicine, Boston, MA; and the Department of Medicine (Dr Gore) and Department of Quantitative Health Sciences (Ms Lessard and Dr Goldberg), University of Massachusetts Medical School (Ms Lessard, Drs Gore and Goldberg), Worcester, MA.

Correspondence to: Mihaela S. Stefan, MD, Baystate Medical Center, 756 Chestnut St, Springfield, MA 01199; e-mail: mihaela.stefan@bhs.org


Funding/Support: This study was funded by the National Institutes of Health [Grant RO1 HL35434]. Dr Stefan is supported by the National Cancer Institute [Grant KM1 CA156726]. Dr Bannuru is supported by the Agency for Healthcare Research and Quality [Grant T32 HS000060]. Drs Bannuru and Stefan are supported by the National Center for Research Resources [Grant UL1 RR025752].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


© 2012 American College of Chest Physicians


Chest. 2012;141(6):1441-1448. doi:10.1378/chest.11-2032
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Background:  There are limited data describing contemporary trends in the management and outcomes of patients with COPD who develop acute myocardial infarction (AMI).

Methods:  The study population consisted of patients hospitalized with AMI at all greater Worcester, Massachusetts, medical centers between 1997 and 2007.

Results:  Of the 6,290 patients hospitalized with AMI, 17% had a history of COPD. Patients with COPD were less likely to be treated with β-blockers or lipid-lowering therapy or to have undergone interventional procedures during their index hospitalization than patients without COPD. Patients with COPD were at higher risk for dying during hospitalization (13.5% vs 10.1%) and at 30 days after discharge (18.7% vs 13.2%), and their outcomes did not improve during the decade-long period under study. After multivariable adjustment, the adverse effects of COPD remained on both in-hospital (OR, 1.25; 95% CI, 0.99-1.50) and 30-day all-cause mortality (OR, 1.31; 95% CI, 1.10-1.58). The use of evidence-based therapies for all patients with AMI increased between 1997 and 2007, with a particularly marked increase for patients with COPD.

Conclusions:  Our results suggest that the gap in medical care between patients with and without COPD hospitalized with AMI narrowed substantially between 1997 and 2007. Patients with COPD, however, remain less aggressively treated and are at increased risk for hospital adverse outcomes than patients without COPD in the setting of AMI. Careful consideration is necessary to ensure that these high-risk complex patients are not denied the benefits of effective cardiac therapies.

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