TY - JOUR
T1 - Association of chronic lung disease with treatments and outcomes patients with acute myocardial infarction
AU - Enriquez, Jonathan R.
AU - de Lemos, James A
AU - Parikh, Shailja V.
AU - Peng, S. Andrew
AU - Spertus, John A.
AU - Holper, Elizabeth M.
AU - Roe, Matthew T.
AU - Rohatgi, Anand K
AU - Das, Sandeep R
N1 - Funding Information:
This research was supported by the American College of Cardiology Foundation's National Cardiovascular Data Registry (NCDR). AR-G is an initiative of the American College of Cardiology Foundation and the American Heart Association with partnering support from the Society of Chest Pain Centers, the American College of Emergency Physicians, and the Society of Hospital Medicine. The registry is funded in part by an independent grant from Merck and by Bristol-Myers Squibb. The authors are solely responsible for the design and conduct of this study, all study analyses, the drafting and editing of the paper and its final contents. The views expressed in this manuscript represent those of the authors, and do not necessarily represent the official views of the NCDR or its associated professional societies identified at www.ncdr.com .
PY - 2013/1
Y1 - 2013/1
N2 - Background: Although chronic lung disease (CLD) is common among patients with myocardial infarction (MI), little is known about the influence of CLD on patient management and outcomes following MI. Methods: Using the National Cardiovascular Data Registry's ACTION Registry-GWTG, demographics, clinical characteristics, treatments, processes of care, and in-hospital adverse events after acute MI were compared between patients with (n = 22,624) and without (n = 136,266) CLD. Multivariable adjustment was performed to determine the independent association of CLD with treatments and adverse events. Results: CLD (17.0% of non-ST-elevation MI [NSTEMI] and 10.1% of ST-elevation MI [STEMI] patients) was associated with older age, female sex, and a greater burden of comorbidities. Among NSTEMI patients, those with CLD were less likely to undergo cardiac catheterization, percutaneous coronary intervention, and coronary artery bypass graft compared to those without; in contrast, no differences were seen in invasive therapies for STEMI patients with or without CLD. Multivariable-adjusted risk of major bleeding was significantly increased in CLD patients with NSTEMI (13.0% vs 8.1%, ORadj = 1.27, 95% CI = 1.20-1.34, P <.001) and STEMI (16.0% vs 10.5%, ORadj = 1.19, 95% CI = 1.10-1.29, P <.001). In NSTEMI, CLD was associated with a higher risk of inhospital mortality (ORadj = 1.21, 95% CI = 1.11-1.33); in STEMI no association between CLD and mortality was seen (ORadj = 1.05, 95% CI = 0.95-1.17). Conclusions: CLD is common among patients with MI and is independently associated with an increased risk for major bleeding. In NSTEMI, CLD is also associated with receiving less revascularization and with increased in-hospital mortality. Special attention should be given to this high-risk subgroup for the prevention and management of complications after MI.
AB - Background: Although chronic lung disease (CLD) is common among patients with myocardial infarction (MI), little is known about the influence of CLD on patient management and outcomes following MI. Methods: Using the National Cardiovascular Data Registry's ACTION Registry-GWTG, demographics, clinical characteristics, treatments, processes of care, and in-hospital adverse events after acute MI were compared between patients with (n = 22,624) and without (n = 136,266) CLD. Multivariable adjustment was performed to determine the independent association of CLD with treatments and adverse events. Results: CLD (17.0% of non-ST-elevation MI [NSTEMI] and 10.1% of ST-elevation MI [STEMI] patients) was associated with older age, female sex, and a greater burden of comorbidities. Among NSTEMI patients, those with CLD were less likely to undergo cardiac catheterization, percutaneous coronary intervention, and coronary artery bypass graft compared to those without; in contrast, no differences were seen in invasive therapies for STEMI patients with or without CLD. Multivariable-adjusted risk of major bleeding was significantly increased in CLD patients with NSTEMI (13.0% vs 8.1%, ORadj = 1.27, 95% CI = 1.20-1.34, P <.001) and STEMI (16.0% vs 10.5%, ORadj = 1.19, 95% CI = 1.10-1.29, P <.001). In NSTEMI, CLD was associated with a higher risk of inhospital mortality (ORadj = 1.21, 95% CI = 1.11-1.33); in STEMI no association between CLD and mortality was seen (ORadj = 1.05, 95% CI = 0.95-1.17). Conclusions: CLD is common among patients with MI and is independently associated with an increased risk for major bleeding. In NSTEMI, CLD is also associated with receiving less revascularization and with increased in-hospital mortality. Special attention should be given to this high-risk subgroup for the prevention and management of complications after MI.
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U2 - 10.1016/j.ahj.2012.09.010
DO - 10.1016/j.ahj.2012.09.010
M3 - Article
C2 - 23237132
AN - SCOPUS:84870921383
SN - 0002-8703
VL - 165
SP - 43
EP - 49
JO - American heart journal
JF - American heart journal
IS - 1
ER -