title: Prevalence and prognosis of chronic obstructive pulmonary disease among 8167 Middle Eastern patients with acute coronary syndrome.
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).
  
  
  OBJECTIVE
  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), beta-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.
authors.affiliation: Department of Cardiology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates.
authors.forename: Hadi A R
authors.initials: HA
authors.lastname: Hadi
authors.forename: Mohammed
authors.initials: M
authors.lastname: Zubaid
authors.forename: Wael
authors.initials: W
authors.lastname: Al Mahmeed
authors.forename: Ayman A
authors.initials: AA
authors.lastname: El-Menyar
authors.forename: Mustafa
authors.initials: M
authors.lastname: Ridha
authors.forename: Alawi A
authors.initials: AA
authors.lastname: Alsheikh-Ali
authors.forename: Rajivir
authors.initials: R
authors.lastname: Singh
authors.forename: Nidal
authors.initials: N
authors.lastname: Assad
authors.forename: Khalid
authors.initials: K
authors.lastname: Al Habib
authors.forename: Jassim
authors.initials: J
authors.lastname: Al Suwaidi
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications* / Q000188:drug therapy; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D016009:Chi-Square Distribution; D015897:Comorbidity; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008877:Middle East / Q000453:epidemiology; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology*; D012042:Registries; D012307:Risk Factors; D015912:Thrombolytic Therapy
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D001241:Aspirin
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