Department of General Medicine, Baystate Medical Center, Springfield, MA; Tufts Clinical and Translational Science Institute, Tufts University School of Medicine, Boston, MA.
Tufts Clinical and Translational Science Institute, Tufts University School of Medicine, Boston, MA.
Chest. 2012 Jun;141(6):1441-1448. doi: 10.1378/chest.11-2032. Epub 2011 Dec 29.
There are limited data describing contemporary trends in the management and outcomes of patients with COPD who develop acute myocardial infarction (AMI).
The study population consisted of patients hospitalized with AMI at all greater Worcester, Massachusetts, medical centers between 1997 and 2007.
Of the 6,290 patients hospitalized with AMI, 17% had a history of COPD. Patients with COPD were less likely to be treated with β-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.
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.
目前关于慢性阻塞性肺疾病（COPD）合并急性心肌梗死（AMI）患者的管理和结局变化趋势的数据十分有限。
研究人群包括 1997 年至 2007 年期间在马萨诸塞州伍斯特市所有大型医疗中心住院治疗的 AMI 患者。
在 6290 例 AMI 住院患者中，17%有 COPD 病史。与无 COPD 患者相比，COPD 患者在住院期间接受β受体阻滞剂或降脂治疗或介入治疗的可能性较小。COPD 患者住院期间（13.5%比 10.1%）和出院后 30 天（18.7%比 13.2%）死亡风险更高，且在研究的 10 年期间，其结局并未改善。多变量调整后，COPD 的不良影响在住院期间（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）方面仍然存在。所有 AMI 患者的循证治疗使用率在 1997 年至 2007 年间均有所增加，COPD 患者的增幅尤其显著。
我们的研究结果表明，1997 年至 2007 年间，因 AMI 住院的 COPD 患者与非 COPD 患者之间的医疗差距显著缩小。然而，与非 COPD 患者相比，COPD 患者的治疗仍不积极，且住院不良结局风险增加。在 AMI 患者中，需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获益。
