title: Closing the mortality gap after a myocardial infarction in people with and without chronic obstructive pulmonary disease.
abstract: OBJECTIVE
  Patients with chronic obstructive pulmonary disease (COPD) have increased mortality following myocardial infarction (MI) compared with patients without COPD. We investigated the extent to which differences in recognition and management after MI could explain the mortality difference.
  
  
  METHODS
  300 161 patients with a first MI between 2003 and 2013 were identified in the UK Myocardial Ischaemia National Audit Project database. Logistic regression was used to compare mortality in hospital and at 180 days postdischarge between patients with and without COPD. Variables relating to inhospital factors (delay in diagnosis, use of reperfusion and time to reperfusion/use of angiography) and use of secondary prevention were sequentially added to models.
  
  
  RESULTS
  Mortality was higher for patients with COPD both inhospital (4.6% vs 3.2%) and at 180 days (12.8% vs 7.7%). After adjusting for inhospital factors, the effect of COPD on inhospital mortality after MI was reduced for both ST-elevation myocardial infarctions (STEMIs) and non-STEMIs (STEMIs OR 1.24 (95% CI 1.10 to 1.41) to 1.13 (95% CI 0.99 to 1.29); non-STEMIs OR 1.34 (95% CI 1.24 to 1.45) to 1.16 (95% CI 1.07 to 1.26)). Adjusting for inhospital factors reduced the effect of COPD on mortality after non-STEMI at 180 days (OR 1.56 (95% CI 1.47 to 1.65) to 1.37 (95% CI 1.31 to 1.44)). Adjusting for use of secondary prevention also reduced the effect of COPD on mortality at 180 days for STEMIs and non-STEMIs (STEMIs OR 1.45 (95% CI 1.31 to 1.61) to 1.25 (95% CI 1.11 to 1.41); non-STEMIs OR 1.37 (95% CI 1.31 to 1.44) to 1.26 (95% CI 1.17 to 1.35).
  
  
  CONCLUSIONS
  Delayed diagnosis, timing and use of reperfusion of a STEMI, use of angiography after a non-STEMI and use of secondary prevention medicines are all potential explanations for the mortality gap after MI in people with COPD.
authors.affiliation: Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Kieran J
authors.initials: KJ
authors.lastname: Rothnie
authors.affiliation: Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK Farr Institute of Health Informatics Research, London, UK.
authors.forename: Liam
authors.initials: L
authors.lastname: Smeeth
authors.affiliation: Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Emily
authors.initials: E
authors.lastname: Herrett
authors.affiliation: Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Neil
authors.initials: N
authors.lastname: Pearce
authors.affiliation: Farr Institute of Health Informatics Research, London, UK Department of Epidemiology and Public Health, University College London, London, UK.
authors.forename: Harry
authors.initials: H
authors.lastname: Hemingway
authors.affiliation: National Heart and Lung Institute, Imperial College London, London, UK.
authors.forename: Jadwiga
authors.initials: J
authors.lastname: Wedzicha
authors.affiliation: Farr Institute of Health Informatics Research, London, UK Barts NIHR Biomedical Research Unit, Queen Mary University of London, London, UK.
authors.forename: Adam
authors.initials: A
authors.lastname: Timmis
authors.affiliation: Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: Quint
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002317:Cardiovascular Agents / Q000627:therapeutic use; D015897:Comorbidity; D017023:Coronary Angiography; D057210:Delayed Diagnosis; D005260:Female; D054625:Healthcare Disparities; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D015425:Myocardial Reperfusion / Q000401:mortality; D016017:Odds Ratio; D011237:Predictive Value of Tests; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D055502:Secondary Prevention; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D002317:Cardiovascular Agents