COPD and acute myocardial infarction

Abstract

COPD is strongly associated with cardiovascular disease, in particular acute myocardial infarction (AMI). Besides shared risk factors, COPD-related factors, such as systemic inflammation and hypoxia, underlie the pathophysiological interaction between COPD and AMI. The prevalence of COPD amongst AMI populations ranges from 7% to 30%, which is possibly even an underestimation due to underdiagnoses of COPD in general. Following the acute event, patients with COPD have an increased risk of mortality, heart failure and arrhythmias during follow-up. Adequate risk stratification can be performed using various imaging techniques, evaluating cardiac size and function after AMI. Conventional imaging techniques such as echocardiography and cardiac magnetic resonance imaging have already indicated impaired cardiac function in patients with COPD without known cardiovascular disease. Advanced imaging techniques such as speckle-tracking echocardiography and T1 mapping could provide more insight into cardiac structure and function after AMI and have proven to be of prognostic value. Future research is required to better understand the impact of AMI on patients with COPD in order to provide effective secondary prevention. The present article summarises the current knowledge on the pathophysiologic factors involved in the interaction between COPD and AMI, the prevalence and outcomes of AMI in patients with COPD and the role of imaging in the acute phase and risk stratification after AMI in patients with COPD.

Sex Differences in the Effects of COPD on Incidence and Outcomes of Patients Hospitalized with ST and Non-ST Elevation Myocardial Infarction: A Population-Based Matched-Pair Analysis in Spain (2016–2018)

“…Accordingly, physicians could consider COPD patients as high risk for complications, and they could be hesitant when recommending aggressive interventions such as cardiac catheterization and PCI, despite these patients potentially benefiting from the receipt of these evidence-based procedures. Although the factors related to this fact have not been adequately clarified, a potential explanation is that patients with COPD are deemed to be older with higher frailty [6]. It has been described that, at the moment of presentation, COPD patients are less likely to receive PCI compared to those without COPD [7,22].…”

“…In addition to common risk factors such as smoking and increasing age, some features related to this chronic pulmonary disease, such as systemic inflammation and hypoxia, underlie the pathophysiological interaction between COPD and MI [6]. Consequently, COPD patients have a higher risk of MI than those without COPD.…”

“…Consequently, COPD patients have a higher risk of MI than those without COPD. On the other hand, COPD is common in patients with MI, with a prevalence that varies from 7% to 28% [6][7][8]. Moreover, several studies have also found an increased risk of death after MI in COPD patients compared with those without COPD [8][9][10].…”

Current developments and future directions in COPD

“…COPD is strongly associated with cardiovascular disease including acute myocardial infarction (AMI), heart failure and arrhythmias [25]. Relative to individuals with normal lung function, COPD patients with Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 2-4 had increased all-cause mortality (HR 1.7, 95% CI 1.4-2.1) and cardiovascular mortality (HR 2.1, 95% CI 1.2-3.6) [26].…”

“…Relative to individuals with normal lung function, COPD patients with Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 2-4 had increased all-cause mortality (HR 1.7, 95% CI 1.4-2.1) and cardiovascular mortality (HR 2.1, 95% CI 1.2-3.6) [26]. Prognosis of patients with COPD after AMI remains worse compared to patients without COPD and after correction for known prognostic factors and smoking [25]. Therefore, it remains important to develop clinically useful biomarkers to better identify COPD patients at higher risk of death.…”