CHICAGO - Chronic obstructive pulmonary disease is a powerful risk factor for in-hospital mortality or cardiogenic shock in patients presenting with ST-elevation MI, according to a large retrospective study.
The clinical inference is that the reduced cardiopulmonary reserve imposed by COPD – a disease often marked by pulmonary hypertension and right ventricular dysfunction – renders the circulatory system less capable of coping with the effects of an MI, Dr. Kohei Wakabayashi said at the annual scientific sessions of the American Heart Association.
In a series of 3,249 patients who underwent emergent percutaneous coronary intervention for STEMI at Washington (D.C.) Hospital Center, 365 were known to have COPD. Their rate of in-hospital mortality or cardiogenic shock (24%) was substantially greater than in patients with no COPD (14%).
Patients with COPD were significantly older, were more often smokers and women, and had a higher prevalence of chronic renal insufficiency, hypertension, and diabetes. In a multivariate logistic regression analysis adjusted for these factors, COPD emerged as the single strongest independent predictor of in-hospital mortality or cardiogenic shock in patients undergoing PCI for STEMI, with an associated 83% increased risk.
The other independent predictors of in-hospital mortality or cardiogenic shock in STEMI patients were the number of diseased vessels, maximum creatine kinase value, and age, according to Dr. Wakabayashi of the center.
He declared having no relevant financial interests.