title: Effect of Chronic Obstructive Pulmonary Disease on In-Hospital Mortality and Clinical Outcomes After ST-Segment Elevation Myocardial Infarction.
abstract: There is controversy regarding in-hospital mortality, revascularization, and other adverse outcomes in patients with ST-segment elevation (STEMI) and chronic obstructive pulmonary disease (COPD). We queried the 2003 to 2011 Nationwide Inpatient Sample databases to identify patients aged ≥18 years with a primary diagnosis of STEMI. Univariate and multivariate analyses were performed to evaluate the association of COPD with in-hospital clinical outcomes. Patients with COPD comprised 13.2% of 2,120,005 patients with STEMI. COPD was associated with older age, Medicare insurance, greater co-morbidities, and lower socioeconomic status. Compared with non-COPD patients, patients with COPD had higher inpatient mortality even after adjustment for multiple potential other factors (12.5% vs 8.6%, adjusted odds ratio [AOR] 1.13, 95% CI 1.11 to 1.15, p <0.001). Patients with COPD were more likely to develop new-onset heart failure (AOR 2.01, 95% CI 1.99 to 2.03), cardiogenic shock (AOR 1.24, 95% CI 1.22 to 1.26), and acute respiratory failure (AOR 2.46, 95% CI 2.43 to 2.50) during their hospital stay. Patients with COPD were less likely to undergo diagnostic angiographies and any revascularization procedures. The mean length of stay (6.0 vs 4.6 days; p <0.001) was greater in patients with COPD, as were hospital average hospital charges ($63,956 vs $58,536; p <0.001). In conclusion, among patients with STEMI, COPD is associated with a greater risk of in-hospital mortality, new-onset heart failure, acute respiratory failure, and cardiogenic shock.
authors.affiliation: Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, Tennessee.
authors.forename: Manyoo
authors.initials: M
authors.lastname: Agarwal
authors.affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, St Luke's University Health Network, Bethlehem, Pennsylvania.
authors.forename: Sahil
authors.initials: S
authors.lastname: Agrawal
authors.affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, Lehigh Valley Health Network, Allentown, Pennsylvania.
authors.forename: Lohit
authors.initials: L
authors.lastname: Garg
authors.affiliation: Department of Internal Medicine, Saint Peter's Healthcare System, New Brunswick, New Jersey.
authors.forename: Aakash
authors.initials: A
authors.lastname: Garg
authors.affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, Vanderbilt Medical Center, Nashville, Tennessee.
authors.forename: Nirmanmoh
authors.initials: N
authors.lastname: Bhatia
authors.affiliation: Division of Pulmonary Medicine and Critical Care, Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, Tennessee.
authors.forename: Dipen
authors.initials: D
authors.lastname: Kadaria
authors.affiliation: Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, Tennessee; Division of Cardiovascular Medicine, Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, Tennessee. Electronic address: glreed@uthsc.edu.
authors.forename: Guy
authors.initials: G
authors.lastname: Reed
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D011159:Population Surveillance; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000453:epidemiology; D012189:Retrospective Studies; D000072657:ST Elevation Myocardial Infarction / Q000150:complications / Q000401:mortality*; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology