Table 3.
Characteristics of included studies – risk of death after MI
| Study | Design and setting | Population | COPD patient characteristics | Maximally adjusted estimate for mortality (95% CI) | Factors adjusted for |
|---|---|---|---|---|---|
| Andell et al 10 | Cohort study within the Swedish SWEDEHEART registry between 2005–2010. | Consecutive patients admitted to Swedish coronary care units. COPD diagnosis ascertained through linkage to the Swedish National Patient Registry. |
Age Mean 75 years (SD, 9) Sex 54% male COPD severity NR Current smokers 32.9% History of CVD Prior MI 13.7% Prior HF 20.2% |
Mortality at one year: HR 1.14 (1.07–1.21) |
Age, sex, smoking, comorbidity (previous MI, previous stroke, heart failure, renal failure, hypertension, diabetes, peripheral artery disease, cancer and previous bleeding), in hospital treatment and discharge medications (heparin, fondaparinux, dalteparin, enoxaparin, glycoprotein IIb/IIa inhibitors, angioplasty, coronary stenting, β-blockers, aspirin, clopidogrel, prasugrel, calcium channel blockers, digoxin, diuretics, statins, nitrates and warfarin). |
| Behar et al 22 | Cohort study in Israel between 1981–1983 | 2276 consecutive patients surviving an MI after admission to 13 coronary care units. Patients with a history of chronic bronchitis or chronic airways obstruction and clinical and/or radiographic findings compatible with COPD during hospitalisation for MI were included. |
Age Mean 66.8 years (SD, 9.7) Sex 79.3% male COPD severity NR Current smokers 43.3% History of CVD Prior MI—28.8% Prior angina—55.4% |
Unadjusted:* In –hospital RR 1.39 (1.16–1.67) 1 year RR 1.34 (1.16–1.55) 5 years RR 1.28 (1.18–1.40) |
|
| Bursi et al 23 | Cohort study of the population in the Rochester Epidemiology project involving residents in Olmsted County, Minnesota from 1979 to 2007 | Local residents in Olmsted County. MI ascertained from medical records compatible with ICD criteria. Information on COPD was also obtained from ICD codes. |
Age Mean 73 years (SD, 11) Sex 59% male COPD severity NR Current smokers 35% History of CVD Those with prior CVD excluded |
HR 1.30 (1.10 to 1.54), mean follow up 4.7 years. | Age, sex, smoking, hypertension, MI type (STEMI/non-STEMI), creatine kinase level, killip class, reperfusion treatment in hospital, use of drugs on discharge (β-blockers, ACEi, diuretics) |
| Dziewierz et al 24 | Cohort study within Krakow Registry of ACS in February 2005-March 2005 and December 2005-January 2006 | 1414 patients with MI admitted to hospital in Krakow, Poland. Those with a previous history of COPD and current treatment with a steroid or bronchodilator were classified as COPD patients. |
Age Mean 71.8 years (SD, 11) Sex 62% male COPD severity NR Current smokers 40.7% History of CVD MI 34.6% Angina 80.2% HF 30.9% |
HR 2.15 (1.30–3.55) | Age, sex, BMI, diabetes, hypertension, hyperlipidaemia, prior angina, prior MI, prior heart failure, left ventricular ejection fraction, prior PCI, prior CABG, prior stroke or transient ischaemic attack, smoking status, peripheral arterial disease, chronic renal insufficiency, parameters on admission (chest pain, cardiogenic shock, heart rate, systolic blood pressure, diastolic blood pressure), time from chest pain onset to admission and type of MI (STEMI or NSTEMI) |
| Enriquez et al 11 | Cross sectional study of National Cardiovascular Data Registry in the USA between January 2008 and December 2010 | 158 890 patients admitted to one of 445 sites with an MI. COPD patients had a history of COPD or were using long term inhaled or oral β-agonists, inhaled anti-inflammatory agents, leukotriene receptor antagonists or inhaled steroids. |
Age STEMI—median 66 years nSTEMI—median 70 years Sex STEMI—60.4% male nSTEMI—57.5% male COPD severity NR Current smokers STEMI—57.0% nSTEMI—41.9% History of CVD STEMI Prior MI—29.7% Prior CHF—15.3% nSTEMI Prior MI—39.% Prior CHF—33.3% |
In-hospital mortality STEMI OR 1.05 (0.95–1.17) Non-STEMI OR 1.21 (1.11–1.33) |
Age, serum creatinine, systolic blood pressure, troponin elevation, heart failure or cardiogenic shock at presentation, ST-segment changes, heart rate and prior peripheral arterial disease. |
| Hadi et al 15 | Cross sectional study of patients hospitalised with ACS in May 2006 and January 2007 to June 2007 in six Middle Eastern countries | 8169 consecutive patients in the Gulf RACE registry presenting with ACS at 65 centres across six countries. COPD patients were identified from 1) medical records or 2) use of COPD medicines. |
Age Median 64 (IQR, 56–71) Sex NR COPD severity NR Current smokers 38.7% History of CVD Prior MI—34.8% Prior angina – 54.4% |
In hospital mortality: OR 0.40 (0.20–1.24) |
Age, sex, cardiogenic shock, use of thrombolysis, use of aspirin, use of β-blocker, use of ACEi |
| Hawkins et al 25 | Cohort study of patients with acute MI enrolled in VALIANT trial | Patients with MI complicated by LVSD and HF. COPD was identified by a questionnaire completed by trial site investigators. |
Age Mean 68.1 (SD, 9.9) Sex 71.1% male COPD severity NR Current smokers 42.0% History of CVD Prior MI—39.9% Prior angina—46.1% Prior HF—27.3% |
HR 1.14 (1.02–1.28) | Age, heart rate, systolic and diastolic blood pressure, weight, baseline creatinine, smoking status, diabetes, dyslipidaemia, hypertension, killip classification, anterior MI, new lower bundle branch block, thrombolytic therapy, primary PCI, coronary artery bypass graft, history of heart failure, atrial fibrillation, previous MI, angina, previous stroke, peripheral arterial disease, renal insufficiency, alcohol abuse, country of enrolment, beta blocker use, randomised treatment |
| Kjoller et al 13 | Cohort study of consecutive patients recruited 1–6 days after an MI | Danish hospitals between May 1990 and July 1992 as part of TRACE study. COPD was identified using either 1) medical records or 2) patient report in addition to use of COPD medicines |
Age Median 70.5 (5–95 percentiles, 50.7–83.5) Sex 68.2% men COPD severity NR Current smokers 60.0% History of CVD Previous MI—25.1% Previous angina—43.9 Previous CHF—28.2% |
Cohort entry to 30 days: HR 0.89 (0.68–1.11) Cohort entry to 7 years: HR 1.15 (1.04–1.28) |
Age, sex, BMI, hypertension, diabetes, smoking status, previous angina, wall motion index, angina, history of CHF, new CHF, atrial fibrillation, bundle branch block, wall motion index, use of thrombolytic therapy |
| Quint et al 26 (abstract) |
Cohort study of patients admitted after a first MI using data from the UK CALIBER database | 8 065 patients admitted to UK hospitals with a first MI between Jan 2003-Dec 2008. COPD was identified using primary care records. |
Age NR Sex NR COPD severity NR Current smokers NR History of CVD NR |
Mortality up to 7 years: HR 1.37 (1.23–1.52) |
Age and sex |
| Raposeiras et al 12 (abstract) |
Cross sectional and cohort study of patients with ACS | 4 497 consecutive patients admitted to Spanish hospitals for ACS. The ascertainment method for COPD was unclear. |
Age NR Sex NR COPD severity NR Current smokers NR History of CVD NR |
In-hospital death OR 1.04 (1.03–1.04) Follow up mortality HR 1.69 (1.41–2.03), median follow up 3.1 years |
GRACE score β-blocker therapy |
| Rha et al 33 (abstract) |
Case control study in Korea AMI registry from 2005 to 2007 | AMI patients in KAMIR |
Age Mean 71.7 (SD 10.0) Sex NR COPD severity NR Current smokers NR History of CVD NR |
Mortality at 8 months OR 2.69, 95% CI could not be calculated from reported information. |
Unadjusted |
| Salisbury et al 27 | 19 centre prospective study of patients presenting with MI in a cohort study | MI patients in PREMIER study restricted to patients discharged alive after MI. Patients were considered to have COPD if they had a documented history of obstructive pulmonary disease (COPD or asthma) or had therapy specific for obstructive pulmonary disease. |
Age Mean 64.5 (SD, 12.4) Sex 61.8% male COPD severity NR Current smokers 37.6% History of CVD Previous MI—29.7% Previous HF—24.3% |
Mortality up to 1 year HR 2.00 (1.44–2.79) |
Age, gender, race, avoidance of health care due to cost, smoking, diabetes, hypertension, CHF, ejection fraction, previous CVD, MI diagnosis type, new onset HF after MI, diseased vessels on angiogram, enrolling site, percentage of MI quality of care indicators of the centre, treatment type |
| Stefan et al 14 | Cross sectional study with follow up of patients hospitalised with AMI at greater Worcester, Massachusetts between 1997–2007 | Patients hospitalised with AMI in greater Worcester, Massachusetts medical centres. COPD patients were identified by previous mention of clinical or radiographic evidence for COPD in their medical record. |
Age Mean 74 years Sex 52.4% male COPD severity NR Current smokers 27.3% History of CVD Prior angina—22.3% Prior HF—38.6% |
In hospital: OR 1.25 (0.97–1.34) 30 day mortality: OR 1.31 (1.10–1.58) |
Age, sex, year of hospitalisation, history of CVD, history of renal failure, type of MI (STEMI/non-STEMI), length of stay, smoking status used in secondary analysis |
*Calculated from reported data.
AMI, acute myocardial infarction; BMI, body mass index; CABG, coronary artery bypass grafting; COPD, chronic obstructive pulmonary disease; CVD, cardiovascular disease; HF, heart failure; LVSD, left ventricular systolic dysfunction; MeSH, Medical Subject Headings; MI, myocardial infarction; NR, not reported; PCI, percutaneous coronary intervention; NSTEMI, non–ST-segment elevation myocardial infarction; STEMI, ST-segment elevation myocardial infarction.