title: Association of chronic lung disease with treatments and outcomes patients with acute myocardial infarction.
abstract: 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%, OR(adj) = 1.27, 95% CI = 1.20-1.34, P < .001) and STEMI (16.0% vs 10.5%, OR(adj) = 1.19, 95% CI = 1.10-1.29, P < .001). In NSTEMI, CLD was associated with a higher risk of inhospital mortality (OR(adj) = 1.21, 95% CI = 1.11-1.33); in STEMI no association between CLD and mortality was seen (OR(adj) = 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.
authors.affiliation: University of Texas Southwestern Medical Center, Dallas, TX, USA. enriquezj@umkc.edu
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Enriquez
authors.forename: James A
authors.initials: JA
authors.lastname: de Lemos
authors.forename: Shailja V
authors.initials: SV
authors.lastname: Parikh
authors.forename: S Andrew
authors.initials: SA
authors.lastname: Peng
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Holper
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Roe
authors.forename: Anand
authors.initials: A
authors.lastname: Rohatgi
authors.forename: Sandeep R
authors.initials: SR
authors.lastname: Das
mesh_terms: D000368:Aged; D002908:Chronic Disease; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008171:Lung Diseases / Q000188:drug therapy / Q000453:epidemiology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000453:epidemiology* / Q000601:surgery; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000401:mortality; D012307:Risk Factors; D016896:Treatment Outcome