Source: International Congress 2014 – Longitudinal studies of respiratory disease
Disease area: Airway diseases

Abstract

Background COPD patients are at increased risk of MI and have increased mortality after an MI compared to people without COPD. It is known that COPD patients are less likely to be prescribed a beta-blocker after an MI compared to people without COPD, but little is known about other differences in treatment or differences in presentation at the time of MI.Methods Patients with a first MI between 2003-2013 were identified from the UK MINAP database. COPD patients had a record of obstructive airway disease, smoking history and were aged >35. Peak troponin, type of MI, initial diagnosis, and treatment were compared between people with and without COPD. Linear and logistic regression were used to compare quantitative and dichotomous outcomes respectively. All models were adjusted for age, sex, smoking, previous cardiovascular disease, renal failure and diabetes.Results 300146 patients with a first MI were identified. 34027 (11.3%) had COPD. COPD patients were more likely to present with an nSTEMI (OR 1.35; 95% CI 1.31-1.39) and had lower peak troponin after adjustment for type of MI (14.5% lower; 95% CI 11.4%-17.4%). COPD patients were more likely to receive an initial diagnosis other than MI (OR 1.68; 95% CI 1.64-1.73), were less likely to receive reperfusion for STEMIs (OR 0.82; 95% CI 0.79-0.86), and less likely to receive aspirin (OR 0.83; 95% CI 0.82-0.86), statins (OR 0.86; 95% CI 0.83-0.88), ACE inhibitors (OR 0.84; 95% CI 0.82-0.86), or beta-blockers (OR 0.24; 95% CI 0.24-0.25) at discharge.Conclusion These findings highlight differences in the recognition and initial management of MI in COPD patients which could be targeted to improve mortality.

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K. Rothnie, H. Hemingway, A. Timmis, L. Smeeth, J. Wedzicha, J. Quint (London, United Kingdom). Presentation and management of COPD patients after MI: Data from the UK myocardial ischaemia national audit project (MINAP). Eur Respir J 2014; 44: Suppl. 58, 2982

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