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Chronic obstructive pulmonary disease in patients admitted with myocardial infarction: impact on therapy and prognosis
Session:
Posters (Sessão 4 - Écran 8) - Síndromes coronárias agudas em populações especiais
Speaker:
Miguel Carias
Congress:
CPC 2023
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.7 Acute Coronary Syndromes - Other
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Miguel Carias De Sousa; Marta Paralta; António Almeida; Francisco Cláudio; Rita Rocha; Bruno Piçarra; Ângela Bento; Manuel Trinca
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="background-color:white"><span style="color:black">Introduction:</span></span></strong><span style="background-color:white"><span style="color:black"> Chronic obstructive pulmonary disease (CPOD) is a common comorbidity in patients admitted with myocardial infarction (MI) and needs to be considered since it can condition therapeutic approach and potentially negatively impact their prognosis.</span></span><br /> <br /> <span style="color:black"><strong><span style="background-color:white">Purpose:</span></strong><span style="background-color:white"> We aim to evaluate the impact of CPOD in therapeutic approach, clinical course and in-hospital mortality in patients admitted with MI.</span><br /> <br /> <strong><span style="background-color:white">Methods:</span></strong><span style="background-color:white"> We retrospectively analysed a population of 2797 patients admitted with MI (C). We divided them into two distinct groups: those with an established diagnosis of CPOD (C1) and those without it (C2). Age, sex, personal history, in-hospital therapeutic, left ventricular ejection fraction (LVEF), electrocardiographical presentation and angioplasty were documented. We defined the following as complications: heart failure (HF), need for invasive and non-invasive mechanical ventilation, reinfarction, newly onset atrial fibrillation, high-grade atrioventricular block and need for temporary cardiac pacing. Mortality, incidence of complications and a combined outcome of both mortality and any of the previous complications were compared between groups. We applied a multivariate analysis to adjust the effect of CPOD to the presence of other potential predictors.</span><br /> <br /> <strong><span style="background-color:white">Results:</span></strong><span style="background-color:white"> C1 consisted of 6,3% of the population (N=173). These patients were older (69,8±10,6 vs 65,5±13,5 years; p<0,001), had a higher prevalence of hypertension (76,3% vs 68,7%; p=0,036) and chronic kidney disease (13,7% vs 5,6%; p<0,001). They presented less frequently with ST-segment elevation MI (38,3 % vs 47,4%; p=0,019), but more often with depressed LVEF (57,9% vs 47,2%, p=0,008). They received less beta-blockers (63,4% vs 80,2%; p<0,001) and had fewer rates of drug-eluting stents application (63,4% vs 80,2%; p<0,001); on the other hand, they were more frequently medicated with calcium-channel blockers (16,7% vs 8,1%; p<0,001) and diuretics (50,0% vs 31,6%; p<0,001) and more bare-metal stents were utilised (52,8% vs 37,4%; p=0,002). The diagnosis of CPOD was not associated with higher mortality in patients with MI, however C1 presented with an increased incidence of complications (33,1% vs 26,0%; OR =1,413 [1,019-1,959]; p=0,037) and of the combined outcome (34,3% vs 26,5%; OR=1,447 [1,046-2,000]; p=0,02). Though multivariate analysis, CPOD tends to be an independent predictor of mortality and/or development of complications, although it narrowly misses to achieve statistical significance (p=0,056); only age, medication with beta-blockers and depressed LVEF were statistically independent predictors.</span><br /> <br /> <strong><span style="background-color:white">Conclusions:</span></strong><span style="background-color:white"> The comorbid diagnosis of CPOD conditions and the choice of medication in patients with MI tends to be an independent predictor of mortality and/or development of in-hospital complications.</span></span></span></span></p>
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