Skip to main content
PMC home page
Clinical Cardiology logoLink to Clinical Cardiology
. 2010 Apr 8;33(4):228–235. doi: 10.1002/clc.20751

Prevalence and Prognosis of Chronic Obstructive Pulmonary Disease Among 8167 Middle Eastern Patients With Acute Coronary Syndrome

Hadi A R Hadi 1, Mohammed Zubaid, Wael Al Mahmeed 1, Ayman A El‐Menyar 3, Mustafa Ridha 2,4, Alawi A Alsheikh‐Ali 5, Rajivir Singh 6, Nidal Assad 3, Khalid Al Habib 7, Jassim Al Suwaidi 3,✉
PMCID: PMC6653010  PMID: 20394044

Abstract

Background

The purpose of this study was to report the prevalence and the significance of clinically recognized chronic obstructive pulmonary disease (COPD) during acute coronary syndrome (ACS).

Hypothesis

COPD in patients with ACS is associated with worse outcome.

Methods

Data were derived from a prospective, multicenter, multinational study of 8167 consecutive patients hospitalized with ACS from February to June 2007 in 6 Middle Eastern countries. Data were analyzed according to the presence or absence of COPD. Demographic, management, and in‐hospital outcomes were compared.

Results

The prevalence of COPD was 5.3%. When compared with non‐COPD patients, COPD patients were older and more likely to have diabetes, hypertension, and dyslipidemia. Atypical presentations were more common in COPD patients (P = 0.001). COPD patients were less likely to be treated with thrombolytic therapy (P = 0.001), β‐blockers (P = 0.001), and glycoprotein IIb/IIIa inhibitors, and more likely to receive angiotensin‐converting enzyme (ACE) inhibitors. Although there was no difference in in‐hospital mortality between the 2 groups, patients with COPD were more likely to have heart failure (P = 0.001). Despite the fact that COPD patients with ST‐segment elevation myocardial infarction were less likely to receive thrombolytic therapy, they suffered more bleeding complications (2.8% vs 1%, P = 0.04), resulting in prolonged hospitalization. COPD was not an independent predictor of increased in‐hospital mortality.

Conclusions

In this large cohort of patients with ACS, the prevalence of COPD was 5·3%. Atypical presentation is common among COPD patients, and this may result in delayed therapy. ACS in COPD patients was associated with higher risk of heart failure and major bleeding complications without increased risk of in‐hospital mortality. Copyright © 2010 Wiley Periodicals, Inc.

Full Text

The Full Text of this article is available as a PDF (180.0 KB).

References

  • 1. Nonkin PM, Dick MM, Baum GL. Myocardial infarction in respiratory insufficiency. Arch Intern Med 1964; 113: 42–45. [DOI] [PubMed] [Google Scholar]
  • 2. Thomas AJ. Coronary heart disease in the presence of pulmonary disease. Br Heart J 1958; 20: 83–91. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 3. Bhargava RK, Woolf CR. Relationships between ischemic heart disease and chronic diffuse pulmonary disease. Chest 1971; 59: 254–261. [DOI] [PubMed] [Google Scholar]
  • 4. Samad IA, Noehren TH. Myocardial infarction in pulmonary emphysema. Chest 1965; 47: 26–29. [DOI] [PubMed] [Google Scholar]
  • 5. Rees HA, Thomas AJ, Rossiter C. The recognition of coronary heart disease in the presence of pulmonary disease. Br Heart J 1964; 26: 233–240. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 6. Schlesinger ZV, Goldbourt U, Medalie JH, Neufeld N, Riss E, Oron D. Ischemic heart disease and pulmonary ventilatory function. Isr J Med Sci 1975; 11: 308–313. [PubMed] [Google Scholar]
  • 7. Mapel DW, Dedrick D, Davis K. Trends and cardiovascular co‐morbidities of COPD patients in the Veterans Administration Medical System, 1991–1999. COPD 2005; 2: 35–41. [DOI] [PubMed] [Google Scholar]
  • 8. Sidney S, Sorel M, Quesenberry CP Jr, et al. COPD and incident cardiovascular disease hospitalizations and mortality: Kaiser Permanente Medical Care Program. Chest 2005; 128: 2068–2075. [DOI] [PubMed] [Google Scholar]
  • 9. Curkendall SM, DeLuise C, Jones JK, et al. Cardiovascular disease in patients with chronic obstructive pulmonary disease, Saskatchewan, Canada: cardiovascular disease in COPD patients. Ann Epidemiol 2006; 16: 63–70. [DOI] [PubMed] [Google Scholar]
  • 10. 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. [DOI] [PubMed] [Google Scholar]
  • 11. Antonelli Incalzi R, Fuso L, De Rosa M, et al. Co‐morbidity contributes to predict mortality of patients with chronic obstructive pulmonary disease. Eur Respir J 1997; 10: 2794–2800. [DOI] [PubMed] [Google Scholar]
  • 12. Ridker PM. Evaluating novel cardiovascular risk factors: can we better predict heart attacks? Ann Intern Med 1999; 130: 933–937. [DOI] [PubMed] [Google Scholar]
  • 13. Danesh J, Whincup P, Walker M, et al. Low‐grade inflammation and coronary heart disease: prospective study and updated meta‐analyses. BMJ 2000; 321: 199–204. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 14. Ross R. Atherosclerosis: an inflammatory disease. N Engl J Med 1999; 340: 115–126. [DOI] [PubMed] [Google Scholar]
  • 15. Ridker PM. Clinical application of C‐reactive protein for cardiovascular disease detection and prevention. Circulation 2003; 107: 363–369. [DOI] [PubMed] [Google Scholar]
  • 16. Wedzicha JA, Seemungal TA, MacCallum PK, et al. Acute exacerbations of chronic obstructive pulmonary disease are accompanied by elevations of plasma fibrinogen and serum IL‐6. Thromb Haemost 2000; 84: 210–215. [PubMed] [Google Scholar]
  • 17. Black S, Kushner I, Samols D. C‐reactive protein. J Biol Chem 2004; 279: 48487–48490. [DOI] [PubMed] [Google Scholar]
  • 18. Pinto‐Plata VM, Müllerova H, Toso JF, et al. C‐reactive protein in patients with COPD, control smokers and non‐smokers. Thorax 2006; 61: 23–28. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 19. Broekhuizen R, Wouters EF, Creutzberg EC, et al. Raised CRP levels mark metabolic and functional impairment in advanced COPD. Thorax 2006; 61: 17–22. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 20. Dev D, Wallace E, Sankaran R, et al. Value of C‐reactive protein measurements in exacerbations of chronic obstructive pulmonary disease. Respir Med 1998; 92: 664–667. [DOI] [PubMed] [Google Scholar]
  • 21. Dahl M, Vestbo J, Lange P, et al. C‐reactive protein as a predictor of prognosis in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2007; 175: 250–255. [DOI] [PubMed] [Google Scholar]
  • 22. Zubaid M, Rashed WA, Al Mahmeed W, et al. Management and outcomes of Middle Eastern patients admitted with acute coronary syndromes in the Gulf Registry of Acute Coronary Events (Gulf RACE).Acta Cardiol 2009; 64: 439–446. [DOI] [PubMed] [Google Scholar]
  • 23. El‐Menyar A, Zubaid M, Rashed W, et al. Comparison of men and women with acute coronary syndrome in six Middle Eastern countries. Am J Cardiol 2009; 104: 1018–1022. [DOI] [PubMed] [Google Scholar]
  • 24. Alsheikh‐Ali AA, Al‐Mallah MH, Al‐Mahmeed W, et al. for Gulf RACE Investigators. Heart failure in patients hospitalized with acute coronary syndromes: observations from the Gulf Registry of Acute Coronary Events (Gulf RACE). Eur J Heart Fail 2009; 11: 1135–1142. [DOI] [PubMed] [Google Scholar]
  • 25. Cannon CP, Battler A, Brindis RG, et al. American College of Cardiology key data elements and definitions for measuring the clinical management and outcomes of patients with acute coronary syndromes: a report of the American College of Cardiology Task Force on Clinical Data Standards (Acute Coronary Syndromes Writing Committee). J Am Coll Cardiol 2001; 38: 2114–2130. [DOI] [PubMed] [Google Scholar]
  • 26. Al Suwaidi J, Reddan DN, Williams K, et al. for GUSTO‐IIb, GUSTO‐III, PURSUIT, and PARAGON‐A Investigators. Prognostic implications of abnormalities of renal function in patients with acute coronary syndromes. Circulation 2002; 106: 974–980. [DOI] [PubMed] [Google Scholar]
  • 27. Salisbury AC, Reid KJ, Spertus JA. Impact of chronic obstructive pulmonary disease on post–myocardial infarction outcomes. Am J Cardiol 2007; 99: 636–641. [DOI] [PubMed] [Google Scholar]
  • 28. Kjøller E, Køber L, Iversen K, Torp‐Pedersen C. Trace Study Group. Importance of chronic obstructive pulmonary disease for prognosis and diagnosis of congestive heart failure in patients with acute myocardial infarction. Eur J Heart Fail 2004; 6: 71–77. [DOI] [PubMed] [Google Scholar]
  • 29. Izbicki G, Ben‐Dor I, Shitrit D, et al. The prevalence of coronary artery disease in end‐stage pulmonary disease: is pulmonary fibrosis a risk factor? Respir Med 2009; 103: 1346–1349. [DOI] [PubMed] [Google Scholar]
  • 30. Nishiyama K, Morimoto T, Furukawa Y, et al. Chronic obstructive pulmonary disease—an independent risk factor for long‐term cardiac and cardiovascular mortality in patients with ischemic heart disease. Int J Cardiol 2009; doi:10.1016/j.ijcard.2009.02.010. Available at: http://www.sciencedirect.com. [DOI] [PubMed] [Google Scholar]
  • 31. Selvaraj CL, Gurm HS, Gupta R, Ellis SG, Bhatt DL. Chronic obstructive pulmonary disease as a predictor of mortality in patients undergoing percutaneous coronary intervention. Am J Cardiol 2005; 96: 756–759. [DOI] [PubMed] [Google Scholar]
  • 32. Berger JS, Sanborn TA, Sherman W, Brown DL. Effect of chronic obstructive pulmonary disease on survival of patients with coronary heart disease having percutaneous coronary intervention. Am J Cardiol 2004; 94: 649–651. [DOI] [PubMed] [Google Scholar]
  • 33. Behar S, Panosh A, Reicher‐Reiss H, Zion M, Schlesinger Z, Goldbourt U. Prevalence and prognosis of chronic obstructive pulmonary disease among 5,839 consecutive patients with acute myocardial infarction. SPRINT Study Group. Am J Med 1992; 93: 637–641. [DOI] [PubMed] [Google Scholar]
  • 34. Dziewierz A, Siudak Z, Dykla D, et al. Management and mortality in patients with non‐ST‐segment elevation vs. ST‐segment elevation myocardial infarction. Data from the Malopolska Registry of Acute Coronary Syndromes. Kardiol Pol 2009; 67: 115–120. [PubMed] [Google Scholar]
  • 35. Brekke PH, Omland T, Smith P, et al. Underdiagnosis of myocardial infarction in COPD—Cardiac Infarction Injury Score (CIIS) in patients hospitalised for COPD exacerbation. Respir Med 2008; 102: 1243–1247. [DOI] [PubMed] [Google Scholar]
  • 36. Nielsen GL, Sørensen HT, Mellemkjoer L, et al. Risk of hospitalization from upper gastrointestinal bleeding among patients taking corticosteroids: a register‐based cohort study. Am J Med 2001; 111: 541–545. [DOI] [PubMed] [Google Scholar]
  • 37. Egred M, Shaw S, Mohammad B, Waitt P, Rodrigues E. Under‐use of beta‐blockers in patients with ischaemic heart disease and concomitant chronic obstructive pulmonary disease. QJM 2005; 98: 493–497. [DOI] [PubMed] [Google Scholar]
  • 38. Gottlieb SS, McCarter RJ, Vogel RA. Effect of beta‐blockade on mortality among high‐risk and low‐risk patients after myocardial infarction. N Engl J Med 1998; 339: 489–497. [DOI] [PubMed] [Google Scholar]
  • 39. Olenchock BA, Fonarow GG, Pan W, Hernandez A, Cannon CP. Get With The Guidelines Steering Committee. Current use of beta blockers in patients with reactive airway disease who are hospitalized with acute coronary syndromes. Am J Cardiol 2009; 103: 295–300. [DOI] [PubMed] [Google Scholar]
  • 40. Chen J, Radford MJ, Wang Y, Marciniak TA, Krumholz HM. Effectiveness of beta‐blocker therapy after acute myocardial infarction in elderly patients with chronic obstructive pulmonary disease or asthma. J Am Coll Cardiol 2001; 37: 1950–1956. [DOI] [PubMed] [Google Scholar]
  • 41. Huiart L, Ernst P, Ranouil X, Suissa S. Oral corticosteroid use and the risk of acute myocardial infarction in chronic obstructive pulmonary disease. Can Respir J 2006; 13: 134–138. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Clinical Cardiology are provided here courtesy of Wiley

RESOURCES