COPD raises risk for type 2 myocardial infarction-related hospitalizations, worse outcomes

NASHVILLE, Tenn. — People with COPD have a greater risk for type 2 myocardial infarction-related admissions and worse in-hospital outcomes, researchers reported at the CHEST Annual Meeting.

Brian Brereton

“Type 2 myocardial infarction occurs due to a mismatch in myocardial oxygen supply and demand. COPD is known to cause increased myocardial oxygen supply and demand mismatch. However, the extent of that mismatch is not clearly delineated,” Brian Brereton, MBBS, clinical fellow in internal medicine at Jersey General Hospital, United Kingdom, told Healio. “So, we aimed to identify factors that contribute to type 2 myocardial infarction in patients with COPD.”

Using the National Inpatient Sample, the researchers identified 33,160 admissions related to type 2 myocardial infarction (MI). Nearly one-third of patients admitted for type 2 MI had COPD.

In unadjusted analyses, COPD was associated with type 2 MI before excluding secondary type 1 MI (OR = 2.55; 95% CI, 2.42-2.68) and after (OR = 2.56; 95% CI, 2.44-2.69), according to the results. Moreover, risk for type 2 MI admissions was elevated in those with COPD in multivariable regression analyses adjusted for sociodemographics (OR = 1.6; 95% CI, 1.54-1.66) and also for comorbidities (OR = 1.26; 95% CI, 1.21-1.32).

The patients with COPD were primarily older, white and women with nonelective admissions compared with the non-COPD cohort, according to Brereton.

Those with COPD also had worse outcomes than those without COPD, including:

• higher all-cause mortality (3.3% vs. 2.8%);
• longer hospital stay (4 vs. 3 days);
• higher medical costs ($9,983 vs. $8,827);
• greater need for home health care (17.8% vs. 15.4%); and
• fewer routine discharges (54.9% vs. 58.1%).

“COPD seems to confer greater morbidity and mortality in these patients with type 2 myocardial infarction,” Brereton told Healio.

The researchers identified several baseline factors that predicted higher odds of type 2 MI in people with COPD, including hyperlipidemia (OR = 1.7; 95% CI, 1.61-1.79), peripheral vascular disease (OR = 1.51; 95% CI, 1.42-1.6), obesity (OR = 1.22; 95% CI, 1.16-1.29), diabetes (OR = 1.17; 95% CI, 1.12-1.23), drug use (OR = 1.64; 95% CI, 1.47-1.82), smoking (OR = 1.16; 95% CI, 1.11-1.22), prior MI (OR = 2.07; 95% CI, 1.97-2.18), percutaneous coronary intervention (OR = 2.56; 95% CI, 2.3-2.88) and coronary artery bypass graft surgery (OR = 1.45; 95% CI, 1.38-1.53), according to the results.

“I think the morbidity of type 2 MI in COPD patients can be significantly reduced if the risk factors are managed. From our study, we noted that the conventional cardiovascular risk factors, if managed correctly, can reduce the risk of type 2 MI in patients with COPD. It would be an incentive for physicians to be more aggressive in addressing these risk factors,” Brereton said.

Brereton said areas for future investigation might be reviewing medication data in these patients and follow-up data after hospital discharge.

Reference:

Desai R, et al. Chest. 2022;doi:10.1016/j.chest.2022.08.160.