The Impact of COPD on Management and Outcomes of Patients Hospitalized With Acute Myocardial Infarction A 10-Year Retrospective Observational Study
The Impact of COPD on Management and Outcomes of Patients Hospitalized With Acute Myocardial Infarction A 10-Year Retrospective Observational Study
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DOI：
10.1378/chest.11-2032
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发表时间：
2012-06-01
期刊：
影响因子：
9.6
通讯作者：
Goldberg, Robert J.
中科院分区：
文献类型：
--
作者：
Stefan, Mihaela S.;Bannuru, Raveendhara R.;Goldberg, Robert J.
背景：描述慢性阻塞性肺疾病急性心肌梗死(AMI)患者治疗和预后的当代趋势的数据有限。方法：研究人群包括1997至2007年间在马萨诸塞州大伍斯特医疗中心住院的急性心肌梗死患者。结果：在6,290名急性心肌梗死住院患者中，17%有COPD病史。与非COPD患者相比，COPD患者在指数住院期间不太可能接受β-受体阻滞剂或降脂治疗，也不太可能接受介入性手术。COPD患者在住院期间(13.5%比10.1%)和出院后30天(18.7%比13.2%)死亡的风险更高，在本研究的十年期间，他们的预后没有改善。经多因素调整后，COPD对住院患者(OR，1.25；95%CI，0.99~1.50)和30天全因死亡率(OR，1.31；95%CI，1.10~1.58)的不良影响仍然存在。1997至2007年间，所有急性心肌梗死患者的循证治疗使用率均有所增加，其中慢性阻塞性肺疾病患者的增加尤为显著。结论：我们的研究结果表明，在1997至2007年间，有COPD和无COPD的急性心肌梗死患者之间的医疗保健差距显著缩小。然而，与在急性心肌梗死时没有COPD的患者相比，COPD患者仍然不那么积极地接受治疗，并面临更高的医院不良结局风险。有必要仔细考虑，以确保这些高危复杂患者不会被剥夺有效心脏治疗的好处。《胸口》2012；141(6)：1441-1448
Background: There are limited data describing contemporary trends in the management and outcomes of patients with COPD who develop acute myocardial infarction (AMI).Methods: The study population consisted of patients hospitalized with AMI at all greater Worcester, Massachusetts, medical centers between 1997 and 2007.Results: Of the 6,290 patients hospitalized with AMI, 17% had a history of COPD. Patients with COPD were less likely to be treated with beta-blockers or lipid-lowering therapy or to have undergone interventional procedures during their index hospitalization than patients without COPD. Patients with COPD were at higher risk for dying during hospitalization (13.5% vs 10.1%) and at 30 days after discharge (18.7% vs 13.2%), and their outcomes did not improve during the decade-long period under study. After multivariable adjustment, the adverse effects of COPD remained on both in-hospital (OR, 1.25; 95% CI, 0.99-1.50) and 30-day all-cause mortality (OR, 1.31; 95% CI, 1.10-1.58). The use of evidence-based therapies for all patients with AMI increased between 1997 and 2007, with a particularly marked increase for patients with COPD.Conclusions: Our results suggest that the gap in medical care between patients with and without COPD hospitalized with AMI narrowed substantially between 1997 and 2007. Patients with COPD, however, remain less aggressively treated and are at increased risk for hospital adverse outcomes than patients without COPD in the setting of AMI. Careful consideration is necessary to ensure that these high-risk complex patients are not denied the benefits of effective cardiac therapies. CHEST 2012; 141(6):1441-1448