Presentation, management and mortality after a first MI in people with and without asthma: A study using UK MINAP data

Abstract

Asthma has been associated with a higher incidence of myocardial infarction (MI), higher prevalence of MI risk factors and higher burden of cardiovascular diseases. However, detailed associations between the presentation and initial management at the time of MI and post-MI outcomes in people with asthma compared to the general population have not been studied. A total of 300,161 people were identified with a first MI over the period 2003–2013 in the Myocardial Ischaemia National Audit Project database, of whom 8922 (3%) had asthma. Logistic regression was used to compare presentation, in-hospital care, in-hospital and 180-day post-discharge all-cause mortality in people with and without asthma adjusting for demographics and comorbidities, diagnosis on arrival and secondary prevention. People with asthma were more likely to have a delay in their MI diagnosis following an STEMI (ST-elevation myocardial infarction; odds ratio (OR) 1.38, confidence interval CI 1.06–1.79) but not an nSTEMI (non-ST-elevation myocardial infarction; OR 1.04, CI 0.92–1.17) compared to people without asthma and a delay in reperfusion (OR 1.19, CI 1.09–1.30) following an STEMI. They were much less likely to be discharged on a beta blocker following an STEMI or nSTEMI (OR 0.24, CI 0.21–0.28 and OR 0.27, CI 0.24–0.30, respectively). There was no difference in in-hospital or 180-day mortality (OR 0.98, CI 0.59–1.62 and OR 0.99, CI 0.72–1.36) following an STEMI or nSTEMI (OR 0.89, CI 0.47–1.68 and OR 1.05, CI 0.85–1.28). Although people with asthma were more likely to have a delay in diagnosis following an STEMI but not an nSTEMI compared to the general population, were more likely to have a delay in reperfusion therapy and were much less likely to receive beta blockers following an STEMI or nSTEMI, there was no difference in the prescriptions of other secondary prevention medications. None of the differences in presentation or management were associated with an increase in all-cause in-hospital or 180-day mortality in people with asthma compared to the general population.

The impact of regular bisoprolol on the response to salbutamol in asthma: A double‐blind randomized placebo‐controlled crossover trial

“…Observational studies and limited controlled data have shown no difference in exacerbations or hospital admissions among asthmatic patients using cardio‐selective beta 1 ‐blockers and we have been unable to find any published reports of cardio‐selective beta 1 ‐blockers precipitating fatal asthma 10–13 . Despite this, cardio‐selective beta 1 ‐blockers remain relatively contraindicated in asthma and clinicians are reluctant to use them 14–19 …”

“…[10][11][12][13] Despite this, cardioselective beta 1 -blockers remain relatively contraindicated in asthma and clinicians are reluctant to use them. [14][15][16][17][18][19] People with asthma are more likely to develop heart disease. 20,21 With an ageing population, many people with asthma have cardiac comorbidities.…”

Statistics on mortality following acute myocardial infarction in 842 897 Europeans

“…P values were calculated from Z values obtained from the difference between the main effect and 95% confidence intervals at each time point between the two countries (see supplementary material). Missing covariates were imputed using the approach suggested for MINAP, imputing unrecorded as 'absent' or 'no' 21 .…”

Understanding the Link Between Adult Asthma and Coronary Artery Disease: A Narrative Review

“…Coronary artery disease (CAD) is a leading cause of death worldwide, and despite lowering age-specific mortality rates in affluent countries, an aging population keeps the absolute numbers rising [ 3 ]. It has the following subtypes: stable ischemic CAD and acute coronary syndrome (ACS).…”