European Journal of Heart Failure Advance Access originally published online on January 27, 2009
European Journal of Heart Failure 2009 11(3):292-298; doi:10.1093/eurjhf/hfp001
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Chronic obstructive pulmonary disease is an independent predictor of death but not atherosclerotic events in patients with myocardial infarction: analysis of the Valsartan in Acute Myocardial Infarction Trial (VALIANT)
1 Aintree Cardiac Centre, University Hospital Aintree, Longmoor Lane, Liverpool L9 7AL, UK
2 Duke University Medical Center, Durham, NC, USA
3 Brigham and Women's Hospital, Boston, MA, USA
4 Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
5 Sahlgrenska University Hospital/Östra, Göteborg, Sweden
6 University of Glasgow, Glasgow, UK
7 Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy
* Corresponding author. Tel: +44 1515292717, Fax: +44 1515292724, Email: nathawkins{at}hotmail.com
 |
Abstract |
|---|
Aims: Chronic obstructive pulmonary disease is an independent predictor of mortality in patients with myocardial infarction (MI). However, the impact on mode of death and risk of atherosclerotic events is unknown.
Methods and results: We assessed the risk of death and major cardiovascular (CV) events associated with chronic obstructive pulmonary disease in 14 703 patients with acute MI enrolled in the Valsartan in Acute Myocardial Infarction (VALIANT) trial. Cox proportional hazards models were used to evaluate the relationship between chronic obstructive pulmonary disease and CV outcomes. A total of 1258 (8.6%) patients had chronic obstructive pulmonary disease. Over a median follow-up period of 24.7 months, all-cause mortality was 30% in patients with chronic obstructive pulmonary disease, compared with 19% in those without. The adjusted hazard ratio (HR) for mortality was 1.14 (95% confidence interval 1.02–1.28). This reflected increased incidence of both non-CV death [HR 1.86 (1.43–2.42)] and sudden death [HR 1.26 (1.03–1.53)]. The unadjusted risk of all pre-specified CV outcomes was increased. However, after multivariate adjustment, chronic obstructive pulmonary disease was not an independent predictor of atherosclerotic events [MI or stroke: HR 0.98 (0.77–1.23)]. Mortality was significantly lower in patients receiving beta-blockers, irrespective of airway disease.
Conclusion: In high-risk patients with acute MI, chronic obstructive pulmonary disease is associated with increased mortality and non-fatal clinical events (both CV and non-CV). However, patients with chronic obstructive pulmonary disease did not experience a higher rate of atherosclerotic events.
Key Words: Chronic obstructive pulmonary disease • Heart failure • Left ventricular systolic dysfunction • Myocardial infarction
Received September 15, 2008; Revised November 2, 2008; Accepted November 20, 2008