Diagnosis of myocardial infarction following hospitalisation for exacerbation of COPD

Abstract

Cardiovascular disease is common in chronic obstructive pulmonary disease (COPD) and raised troponin is common in exacerbations. However, the prevalence of myocardial infarction following hospitalisation for exacerbation of COPD is unknown.Patients aged o40 yrs hospitalised with acute exacerbation of COPD (n5242) with o10 packyrs of cigarette smoking were included in a prospective case series conducted in four hospitals. Patients whose primary presenting complaint was chest pain or who had an alternative diagnosis were excluded. Chest pain histories, serial ECGs and troponin levels were obtained.The mean¡SD age was 69¡9 yrs; 108 (45%) patients were male and almost half were current smokers. 124 (51%; 95% CI 48-58%) patients had chest pain, which was exertional in 62 (26%). 24 (10%) had raised troponin, among whom, 20 (8.3%; 95% CI 5.1-12.5%) had chest pain and/or serial ECG changes, fulfilling the 2007 Universal Definition of Myocardial Infarction. Neither chest pain (p50.77) nor serial ECG changes (p50.39) were associated with raised troponin.Raised troponin, chest pain and serial ECG changes are common in patients admitted to hospital with exacerbation of COPD. Overall, one in 12 patients met the criteria for myocardial infarction. Whether these patients would benefit from further cardiac investigation is unknown.KEYWORDS: Chest pain, chronic obstructive pulmonary disease, ECG, myocardial infarction, troponin C oronary heart disease is a major cause of mortality in chronic obstructive pulmonary disease (COPD) [1,2]. Both conditions share common risk factors, such as smoking and socioeconomic status, and reduced forced expiratory volume in 1 s (FEV1), a characteristic feature of COPD, is an independent risk factor for cardiovascular mortality [3].In studies using routine clinical data, diagnosis with myocardial infarction (MI) appears to be more common following exacerbations in patients with COPD [4,5], while raised troponin has been found to be associated with increased mortality in exacerbation of COPD [6][7][8],Coronary events may present without chest pain [9], can be missed even in simple chest pain presentations [10] and may be more likely to be missed in patients presenting with acute exacerbation of COPD who also report acute breathlessness and chest tightness.Raised troponin is common in patients admitted to hospital with exacerbation of COPD [6][7][8]; however, we are unaware of any prospective study that has investigated this group for clinical or electrocardiography features of MI.Therefore, we undertook a prospective case series to identify the prevalence of MI in patients admitted to hospital with acute exacerbation of COPD. The prevalence of MI was calculated along with 95% confidence intervals using the exact binomial test. In exploratory analyses, associations between patient characteristics and raised troponin concentrations were examined using Fisher's exact test, for which we report all associations where the p-value was ,0.10. Analyses were performed using SAS version 9.2 (SAS In...

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“…These are usually precipitated by viral/bacterial infection and/or air pollution and are characterised by increasing breathlessness, and/or cough, sputum expectoration and malaise. Exacerbations are associated with accelerated rate of lung function decline [14], reduced physical activity [15], reduced quality of life [16], increased mortality [17] and increased risk of comorbidities such as acute myocardial infarction and stroke [18]. It has been estimated that exacerbations account for about 60% of the £1billion NHS expenditure on COPD [19].…”

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