Incidence, Characteristics, and Outcomes of Acute Myocardial Infarction among Patients Admitted with Acute Exacerbation of Chronic Obstructive Lung Disease

Figures & data

Figure 1. Temporal trends in AMI among patients with acute COPD exacerbation in the United States between 2003 and 2016. AMI; acute myocardial infarction, COPD; chronic obstructive pulmonary disease.

Table 1. Baseline characteristics of the study cohort.

Baseline Characteristics	Unmatched Cohorts			Propensity Score-Matched Cohorts
	No-AMI (n = 6,838,197)	AMI (n = 56,515)	P-value	No-AMI (n = 56,486)	AMI (n = 56,486)	P-value
Demographics/socioeconomics
Age-Mean (SD)	69 ± 12	73 ± 10	<0.001	73 ± 10.5	74 ± 10.3	0.04
Age Groups			<0.001			0.34
18–44	2.7%	0.5%		0.4%	0.5%
45–64	35.6%	23.9%		23.2%	23.9%
65–85	54%	64.4%		65.4%	64.4%
>85	7.7%	11.3%		11.0%	11.2%
Female Sex	55.8%	53.9%	<0.001	53.7%	53.9%	0.89
Race			<0.001			0.22
White	81.3%	83.2%		83.5%	82.8%
Black	10.8%	8.8%		8.7%	9.0%
Hispanic	4.7%	4.4%		4.2%	4.4%
Primary Payer
Medicare/Medicaid	82.2%	86.2%	<0.001	86.5%	86.2%	0.90
Private Insurance	12.5%	9.8%		9.7%	9.8%
Self-Pay/Others	5.3%	3.9%		3.8%	3.9%
Lowest 25% household income	36.5%	34.7%	<0.001	35.4%	34.9%	0.39
Clinical risk factors
Hypertension	61.2%	64.5%	<0.001	64.0%	64.5%	0.44
Diabetes	29.0%	30.0%	<0.001	30.5%	30.0%	0.30
Hyperlipidemia	29.6%	35.8%	<0.001	35.8%	35.8%	0.86
Prior Coronary Artery Disease	27.4%	48.9%	<0.001	49.2%	48.9%	0.44
Atrial Fibrillation	15.2%	23.3%	<0.001	23.4%	23.3%	0.99
Smoking	48.9%	43.9%	<0.001	42.7%	43.9%	0.08
Home Oxygen Dependence	16.1%	16.3%	0.24	15.9%	16.3%	0.53
Congestive Heart Failure	26.2%	47.8%	<0.001	47.6%	47.8%	0.86
Chronic Kidney Disease	9.9%	18.4%	<0.001	17.5%	18.4%	0.09
Peripheral Vascular Disease	6.6%	11.7%	<0.001	11.2%	11.6%	0.30
Carotid Artery Disease	0.7%	1.7%	<0.001	1.7%	1.7%	0.99
Prior Sternotomy	6.6%	8.3%	<0.001	8.9%	8.3%	0.19
Liver Cirrhosis	0.7%	0.9%	<0.001	0.8%	0.9%	0.31
Alcohol Use Disorders	3.7%	3.6%	0.1	3.8%	3.6%	0.34
Prior Stroke	4.1%	4.7%	<0.001	4.7%	4.7%	0.99
Conduction Disorders	1.7%	4.2%	<0.001	4.1%	4.2%	0.81
Prior Pacemaker	3.1%	2.8%	<0.001	2.9%	2.8%	0.55
Prior Defibrillator	1.5%	1.5%	0.59	1.6%	1.5%	0.55
Anemia	14.8%	20.7%	<0.001	20.2%	20.7%	0.45

AMI; acute myocardial infarction, n; number, SD; standard deviation, COPD; Chronic Obstructive Pulmonary Disease.

Table 2. Outcomes of patients admitted with acute COPD exacerbation stratified by the occurrence of acute myocardial infarction.

In-Hospital outcome	Unmatched Cohorts			Propensity Score-Matched Cohorts
	No-AMI (n = 6,838,197)	AMI (n = 56,515)	P-value	No-AMI (n = 56,486)	AMI (n = 56,486)	P-value
Invasive Coronary Assessment/Intervention
STEMI	0%	13.7%	<0.001	0%	13.7%	<0.001
NSTEMI	0%	86.4%	<0.001	0%	86.4%	<0.001
Coronary Angiography	0.8%	18.1%	<0.001	1.2%	18.1%	<0.001
PCI	0.1%	4.1%	<0.001	0.2%	4.1%	<0.001
Bare Metal Stents*	29.4%	29.0%	0.7	29.5%	29.0%	0.3
CABG	0%	0.3%	<0.001	0%	0.3%	<0.001
Clinical Outcomes
In-Hospital Mortality	1.5%	12.2%	<0.001	2.1%	12.1%	<0.001
Stroke	0.1%	1.1%	<0.001	0.2%	1.1%	<0.001
Acute Kidney Injury	5.4%	18.0%	<0.001	8.1%	18.0%	<0.001
New Dialysis	0.1%	0.8%	<0.001	0.2%	0.8%	<0.001
Vascular Complications	0.1%	0.8%	<0.001	0.2%	0.8%	<0.001
Blood Transfusion	2.3%	8.9%	<0.001	3.2%	8.9%	<0.001
Mechanical Ventilations	1.0%	11.0%	<0.001	1.2%	11.0%	<0.001
Prolonged Ventilations	0.8%	9.4%	<0.001	0.9%	9.4%	<0.001
Noninvasive Ventilations	4.7%	12.1%	<0.001	4.9%	12.1%	<0.001
Tracheostomy	0.2%	1.8%	<0.001	0.2%	1.8%	<0.001
Gastrostomy	0.2%	1.2%	<0.001	0.3%	1.2%	<0.001
Resource Utilization
Discharge Disposition			<0.001			<0.001
Home	82.2%	60.4%		79.2%	60.5%
Non-Home	15.7%	38.0%		19.6%	38.0%
Length of stay	4 (2–5)	6 (3–10)	<0.001	4 (2–6)	6 (3–10)	<0.001
Hospital Cost (US dollar)	5726 (3752–9011)	12431 (7370–22073)	<0.001	5952 (4126–9582)	11683 (6614–21054)	<0.001

STEMI; ST- elevated myocardial infarction, NSTEMI; Non-ST elevated myocardial infarction, AMI; acute myocardial infarction, PCI; percutaneous coronary intervention, CABG; coronary artery bypass grafting, US; United States, * among patients who received PCI.

Table 3. Outcomes of patients admitted with AMI stratified by management strategy.

In-Hospital Outcome	Unmatched Cohorts			Propensity Score-Matched Cohorts
	Noninvasive N = 46,170	Invasive N = 10,345	P Value	Noninvasive N = 9991	Invasive N = 9991	P Value
In-Hospital Mortality	13.8%	4.9%	<0.001	10.0%	5.0%	<0.001
Stroke	1.2%	0.7%	<0.001	0.8%	0.7%	0.72
Acute Kidney Injury	18.7%	14.8%	<0.001	16.7%	15.1%	0.16
New Dialysis	0.9%	0.7%	0.16	0.9%	0.7%	0.73
Vascular Complications	0.4%	2.9%	<0.001	0.3%	2.9%	<0.001
Blood Transfusion	9.2%	7.9%	<0.001	8.1%	8.1%	0.99
Mechanical Ventilation	11.3%	9.4%	<0.001	10.7%	9.4%	0.19
Prolonged Ventilation	9.9%	7.2%	<0.001	9.7%	7.3%	0.009
Noninvasive Ventilation	12.5%	10.1%	<0.001	11.7%	10.1%	0.12
Tracheostomy	1.8%	1.5%	0.04	1.7%	1.6%	0.81
Gastrostomy	1.3%	0.8%	<0.001	1.2%	0.8%	0.27
Discharge Disposition						<0.001
Home	56.8%	75.0%		55.9%	70.7%
Non-Home	41.4%	24.4%		33.0%	23.8%
Length of stay	6 (3-9)	6 (4-10)	<0.001	5 (3-9)	6 (4-11)	<0.001
Hospital Cost (US dollar)	11091 (6680–19715)	18394 (12165–29704)	<0.001	9921 (5859–18033)	17857 (11418–29042)	<0.001

AMI; acute myocardial infarction, PCI; percutaneous coronary intervention, CABG; coronary artery bypass grafting, US; United States.

Table 4. Univariate and multivariate logistic regression analysis for predictors of undergoing invasive coronary assessment strategy.

Predictors of Invasive Strategy	Univariate Regression				Multivariate Regression
	OR	95% CI		P-Value	OR	95% CI		P-Value
		Lower	Upper			Lower	Upper
Age (per year)	0.96	0.96	0.97	<0.001	0.96	0.96	0.97	<0.001
Female Sex	1.11	1.06	1.17	<0.001	1.11	1.06	1.17	<0.001
Non-White Race (vs. White)	0.85	0.79	0.90	<0.001	0.84	0.79	0.90	<0.001
Diabetes	0.87	0.82	0.91	<0.001	0.87	0.82	0.92	<0.001
Hypertension	1.03	0.98	1.09	0.23
Dyslipidemia	1.11	1.05	1.17	<0.001	1.12	1.06	1.18	<0.001
Known Coronary Artery Disease	3.44	3.26	3.62	<0.001	3.45	3.27	3.63	<0.001
Atrial Fibrillation	0.87	0.82	0.93	<0.001	0.88	0.82	0.93	<0.001
Smoking	1.35	1.28	1.42	<0.001	1.35	1.29	1.42	<0.001
Home Oxygen Dependence	0.83	0.78	0.89	<0.001	0.83	0.78	0.89	<0.001
Congestive Heart Failure	0.78	0.75	0.82	<0.001	0.78	0.75	0.82	<0.001
Chronic Kidney Disease	0.79	0.74	0.85	<0.001	0.80	0.74	0.85	<0.001
Peripheral Vascular Disease	1.22	1.14	1.31	<0.001	1.22	1.14	1.31	<0.001
Carotid Artery Disease	1.72	1.46	2.03	<0.001	1.72	1.46	2.03	<0.001
Liver Cirrhosis	0.57	0.43	0.77	<0.001	0.57	0.42	0.77	<0.001
Prior Stroke	0.87	0.77	0.98	0.017	0.87	0.77	0.98	0.018
Cardiogenic Shock	1.85	1.52	2.24	<0.001	1.84	1.52	2.23	<0.001
Weekend Admission	0.91	0.86	0.96	<0.001	0.90	0.86	0.96	<0.001
Anemia	0.79	0.74	0.85	<0.001	0.79	0.75	0.85	<0.001
Rural Hospital Location	0.40	0.37	0.43	<0.001	0.40	0.37	0.43	<0.001
Non-Teaching Hospital	0.72	0.68	0.76	<0.001	0.72	0.68	0.76	<0.001

OR; odds ratio, CI; confidence interval.