Impact of chronic obstructive pulmonary disease on in-hospital morbidity and mortality in patients with ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention

Background: Patients with chronic obstructive pulmonary disease (COPD) presenting with ST-segment elevation myocardial infarction (STEMI) are less likely to beneficiate of primary percutaneous coronary intervention (pPCI), and have poorer prognosis. We aimed to evaluate the impact of COPD on the in-hospital outcomes of pPCI-treated STEMI patients. Methods: Data were collected from 418 STEMI patients treated by pPCI. Inotropics and diuretics usage, cardiogenic shock, asystole, kidney dysfunction, and left ventricular ejection fraction were used as markers of hemodynamic complications. Atrial and ventricular fibrillation, conduction disorders, and antiarrhythmics usage were used as markers of arrhythmic complications. In-hospital mortality was evaluated. The associations between these parameters and COPD were assessed. Results: COPD was present in 7.42% of STEMI patients. COPD patients were older (p = 0.02) and less likely to receive beta-blockers (OR 0.29; 95% CI 0.13-0.64; p < 0.01). They had higher Killip class on admission (p < 0.001), received more often inotropics (p < 0.001) and diuretics (p < 0.01), and presented more often atrial (p = 0.01) and ventricular fibrillation (p = 0.02). Unadjusted in-hospital mortality was higher in COPD patients (OR 4.18, 95% CI 1.55-11.30, p < 0.01). After adjustment for potentially confounding factors except beta-blockers, COPD remained an independent predictor of in-hospital mortality (p = 0.02). After further adjustment with beta-blocker therapy, no excess mortality was noted in COPD patients. Conclusions: Despite being treated by pPCI, COPD patients with STEMI are more likely to develop hemodynamic and arrhythmic complications, and have higher in-hospital mortality. This appears to be due to lower beta-blockers usage in COPD patients. Increasing beta-blockers usage in COPD patients with STEMI may improve survival. (C) 2017 Elsevier B.V. All rights reserved.