Association of chronic lung disease with treatments and outcomes patients with acute myocardial infarction

Jonathan R. Enriquez, James A de Lemos, Shailja V. Parikh, S. Andrew Peng, John A. Spertus, Elizabeth M. Holper, Matthew T. Roe, Anand K Rohatgi, Sandeep R Das

Research output: Contribution to journalArticle

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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%, 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.

Original languageEnglish (US)
Pages (from-to)43-49
Number of pages7
JournalAmerican Heart Journal
Volume165
Issue number1
DOIs
StatePublished - Jan 2013

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Lung Diseases
Chronic Disease
Myocardial Infarction
Hospital Mortality
Registries
Hemorrhage
Percutaneous Coronary Intervention
Cardiac Catheterization
Coronary Artery Bypass
Comorbidity
Therapeutics
Demography
Transplants
Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Association of chronic lung disease with treatments and outcomes patients with acute myocardial infarction. / Enriquez, Jonathan R.; de Lemos, James A; Parikh, Shailja V.; Peng, S. Andrew; Spertus, John A.; Holper, Elizabeth M.; Roe, Matthew T.; Rohatgi, Anand K; Das, Sandeep R.

In: American Heart Journal, Vol. 165, No. 1, 01.2013, p. 43-49.

Research output: Contribution to journalArticle

Enriquez, Jonathan R. ; de Lemos, James A ; Parikh, Shailja V. ; Peng, S. Andrew ; Spertus, John A. ; Holper, Elizabeth M. ; Roe, Matthew T. ; Rohatgi, Anand K ; Das, Sandeep R. / Association of chronic lung disease with treatments and outcomes patients with acute myocardial infarction. In: American Heart Journal. 2013 ; Vol. 165, No. 1. pp. 43-49.
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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{\%}, 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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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

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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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