Underdiagnosis of myocardial infarction in COPD – Cardiac Infarction Injury Score (CIIS) in patients hospitalised for COPD exacerbation

Brekke, P.; Omland, Torbjørn; Smith, Pål; Søyseth, Vidar

doi:10.1016/j.rmed.2008.04.010

Cited by 103 publications

(77 citation statements)

References 23 publications

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“…The current study extends these findings in a larger cohort of patients from another part of the Middle East in the current era, where significant improvements have occurred in the understanding and therapy of both COPD and ACS over that available in the 1980s. Furthermore, it reports for the first time a high prevalence of atypical presentations (mainly dyspnea) in up to 32% of these patients, which could be misdiagnosed as COPD exacerbation; this in part may explain underdiagnosis of MI in COPD patients reported previously by Brekke et al 35 Previous studies included an older age group than the Gulf RACE with variable incidence of smoking history, other cardiovascular risk factors, and ethnicities that could explain the variability between the findings of SPRINT and the current study. We observed increased major bleeding complications in COPD patients with STEMI.…”

Section: Discussionmentioning

confidence: 74%

Prevalence and Prognosis of Chronic Obstructive Pulmonary Disease Among 8167 Middle Eastern Patients With Acute Coronary Syndrome

Hadi

Zubaid²,

Mahmeed

et al. 2010

Clinical Cardiology

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Background: The purpose of this study was to report the prevalence and the significance of clinically recognized chronic obstructive pulmonary disease (COPD) during acute coronary syndrome (ACS). Hypothesis: COPD in patients with ACS is associated with worse outcome. Methods: Data were derived from a prospective, multicenter, multinationalstudy of 8167 consecutive patients hospitalized with ACS from February to June 2007 in 6 Middle Eastern countries. Data were analyzed according to the presence or absence of COPD. Demographic, management, and in-hospital outcomes were compared. Results: The prevalence of COPD was 5.3%. When compared with non-COPD patients, COPD patients were older and more likely to have diabetes, hypertension, and dyslipidemia. Atypical presentations were more common in COPD patients (P = 0.001). COPD patients were less likely to be treated with thrombolytic therapy (P = 0.001), β-blockers (P = 0.001), and glycoprotein IIb/IIIa inhibitors, and more likely to receive angiotensin-converting enzyme (ACE) inhibitors. Although there was no difference in in-hospital mortality between the 2 groups, patients with COPD were more likely to have heart failure (P = 0.001). Despite the fact that COPD patients with ST-segment elevation myocardial infarction were less likely to receive thrombolytic therapy, they suffered more bleeding complications (2.8% vs 1%, P = 0.04), resulting in prolonged hospitalization. COPD was not an independent predictor of increased in-hospital mortality. Conclusions: In this large cohort of patients with ACS, the prevalence of COPD was 5·3%. Atypical presentation is common among COPD patients, and this may result in delayed therapy. ACS in COPD patients was associated with higher risk of heart failure and major bleeding complications without increased risk of in-hospital mortality.

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Section: Discussionmentioning

confidence: 74%

Prevalence and Prognosis of Chronic Obstructive Pulmonary Disease Among 8167 Middle Eastern Patients With Acute Coronary Syndrome

Hadi

Zubaid²,

Mahmeed

et al. 2010

Clinical Cardiology

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“…Bir diğer mekanizmaya göre, KOAH hastalarının önemli bir kısımında koroner kalp hastalığı vardır ve bazı hastalarda teşhis edilmemiş spontan tip 1 MI (plak rüptür, fissür ya da diseksiyonu) mevcuttur. Bir diğer mekanizma ise taşikardi ve hipoksi sonucu oksijen sunum ve tüketimi arasında oluşan dengedeki bozulmanın tip 2 miyokard infarktüsüne (vazokonstriksiyon ilişkili miyokardial kan akımı azalması ve ciddi iskemi ya da MI gelişmesi) neden olmasıdır (7,8). Pekçok çalışma, KOAH'ta troponin artışının bir mortalite prediktörü olduğu izlenimini vermektedir (9-13).…”

Section: Discussionunclassified

“…Ülkemizde yapılan yayınlarda bu bulgu bulunamamıştır (14,15). Bazı çalışmalar, KOAH'ta troponin artışının %25 hatta bazı çalışmalarda %50 oranında olduğunu bildirmektedir (9,11 (8). MI teşhisinin bu hastalarda normalden daha az sıklıkla konulduğu düşünülmektedir (8).…”

Section: Discussionunclassified

“…Bazı çalışmalar, KOAH'ta troponin artışının %25 hatta bazı çalışmalarda %50 oranında olduğunu bildirmektedir (9,11 (8). MI teşhisinin bu hastalarda normalden daha az sıklıkla konulduğu düşünülmektedir (8). Çalışmamızda KOAH hastalarında sTnI yüksekliği ile EKG değer-lendirmeleri (st değişikliği, blok, atriyal fibrilasyon açısından) arasın-da herhangi bir istatistiksel bağlantı kurulamadı.…”

Section: Discussionunclassified

“…Bizim çalışmamızda çalışma dışı bırakılma kriterleri titizlikle uygulanmıştır. 10 yılı geçen süredir üzerinde çeşitli tartışma-lar yapılan ve çelişkili sonuçların yayınlandığı bu konuda olgu seçimi anahtar rol oynamaktadır (8)(9)(10)(11)(12)(13)(14)(15)(16)(17).…”

Section: Discussionunclassified

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Elevated Troponin Levels in Acute Exacerbation of COPD

Erdogan¹,

Güloǧlu²,

Orak³

et al. 2013

JAEM

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Objective: To investigate the correlation between serum troponin elevation and vital signs, arterial blood gases, length of stay, prognosis in patients admitted to the emergency department with an exacerbation of chronic obstructive pulmonary disease. Material and Methods: This prospective study was performed on 100 COPD patients admitted to the Dicle University Hospital Emergency Department between January 2008 and June 2008. Ki square test was used for univariate analyses of categorical variables, Mann-Whitney U Test was used for continuous variables. Results: In our study, 11% of patients were in the elevated sTnI group. Elevation of sTnI had no statistical relation with vital signs, electrocardiographic datas or arterial blood gases. Elevation of sTnI had no statistical relation with length of stay (p=0.863), ICU admission (p=0.619) or mortality (p=0.061). Conclusion: High sTnI in COPD patients has no predictive value for length of stay, ICU admission and prognosis. (JAEM 2013; 12: 130- GirişTroponinler, kreatin kinaz(CK) ve kreatin kinaz-MB' ye (CK-MB) göre miyokardiyal nekrozu göstermede oldukça spesifik belirleyicilerdir (1-3). Kardiyak troponin düzeylerinin pulmoner emboli, ciddi konjestif kalp yetmezliği, direkt kardiyak yaralanma, elektrik çarpma-sı, toksin etkisi (adriamycin, 5-fluorouracil, trastuzumab, yılan zehiri), viral miyokardit, perikardit, serebrovasküler olay, sepsis, taşiaritmiler ve lober pnömoni gibi non-iskemik durumlarda, kronik obstrüktif akciğer hastalıklı (KOAH) olgularda da yükseldiği bildirilmiştir (4, 5). KOAH endüstriyel topluluklarda hala artmakta olan yegane mortalite nedenidir. Yavaş seyri, sürekli kötüleşen atakları, yatış ihtiyacı ve mortalitesiyle KOAH bir halk sağlığı sorunudur (1, 6).Çalışmamızda, akut dönemdeki KOAH'lı olgularda serum troponin I (sTnI) düzeylerinin vital bulgular, arteriyel kan gazları (AKG) rutin biyokimyasal tetkikler hastanede kalış, prognoz ve mortalite ile ilişki-sinin araştırılması amaçlanmıştır.

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Civil engineering airman at increased risk for injuries and injury‐related musculoskeletal disorders

Webb

Wells

2010

American J Industrial Med

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Underdiagnosis of myocardial infarction in COPD – Cardiac Infarction Injury Score (CIIS) in patients hospitalised for COPD exacerbation

Abstract: Unrecognised MI is common in patients hospitalised with COPD exacerbation. Less than one-third of patients with ECG evidence of previous MI by the CIIS system actually have the diagnosis in their medical records.

Cited by 103 publications

References 23 publications

Prevalence and Prognosis of Chronic Obstructive Pulmonary Disease Among 8167 Middle Eastern Patients With Acute Coronary Syndrome

Prevalence and Prognosis of Chronic Obstructive Pulmonary Disease Among 8167 Middle Eastern Patients With Acute Coronary Syndrome

Elevated Troponin Levels in Acute Exacerbation of COPD

Civil engineering airman at increased risk for injuries and injury‐related musculoskeletal disorders

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