Impact of chronic obstructive pulmonary disease on early and late mortality in patients after an acute myocardial infarction. Insights from FAST-MI 2005 registry

Background: Patients with chronic obstructive pulmonary disease (COPD)have worse prognosis after acute myocardial infarction (AMI) but it remains unclear whether this is related to comorbidities, inadequate treatment, or to the COPD itself. Using data from the FAST-MI registry, we investigated the impact of history of COPD on acute and long term outcomes after MI. Methods: FAST-MI 2005 included consecutive patients with AMI over 1 month in 223 French centres. Baseline characteristics and hospital management were compared between groups according to COPD status at inclusion. All-cause mortality at 30 days and 5 year were compared between COPD group using Cox multivariate analysis and paired comparison (matched pairs on a propensity score to have a history of COPD) Results: Among 3670 AMI patients included, 179 (5%) had a history of COPD. COPD pts were older, had more diabetes, previous stroke, heart and renal failure and higher GRACE score. They less often received betablockers, coronary angiography and reperfusion/revascularisation. In-hospital death was twice as high in CPD patients (12.8% vs 5.2%, p<0.0001), as was 5 year mortality (58% vs 28%), p<0.001). After adjustment for baseline characteristics, comorbidities and hospital management, COPD was associated with higher 30-day (hazard ratio, HR 2.4 [1.2; 4.5]) and 5 year mortality (HR 1.6 [1.4; 1.8]) in the overall population and higher 5 year mortality among survivors at 30 days (HR 2.3 [1.9; 2.8]). After matching on a propensity score (132 pairs), there was no difference in in-hospital mortality, but 5 year mortality remained higher in COPD patients (56.1% vs 41.7%, p=0.02). ![Figure][1] Conclusions: COPD patients represent a high risk subgroup for early and long term death, irrespective of co-morbidities and hospital management. [1]: pending:yes