NCDR Study Shows Chronic Lung Disease Presents High Mortality Risk in Non-STEMI Patients

A study published in the January 2013 issue of the American Heart Journal found that chronic lung disease (CLD) is independently associated with an increased risk of in-hospital mortality in non-ST-elevation myocardial infarction (non-STEMI) patients, and is associated with an increased risk of major bleeding in both non-STEMI and STEMI patients.

Using data from the ACTION Registry®-GWTG™, the study looked at demographics, clinical characteristics, treatments, processes of care, and in-hospital adverse events after acute MI in 158,890 patients with (n=22,624) and without (n=136,266) CLD.

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Results showed that multivariable adjusted risk of major bleeding was significantly increased in CLD patients with non-STEMI (13.0 vs. 8.1 percent, ORadj = 1.27, 95 percent CI = 1.20-1.34, P < .001) and STEMI (16.0 vs. 10.5 percent, ORadj = 1.19, 95 percent CI = 1.10-1.29, P < .001). Further, in patients with non-STEMI, CLD was associated with a higher risk of inhospital mortality (ORadj = 1.21, 95 percent CI = 1.11-1.33); while in patients with STEMI, no association between CLD and mortality was found (ORadj = 1.05, 95 percent CI = 0.95-1.17). In addition, among patients with STEMI or non-STEMI, those with CLD had higher unadjusted rates of death, reinfarction, cardiogenic shock, heart failure, major bleeding and red blood cell transfusions than those without chronic lung disease.

The authors also found that CLD patients with non-STEMI were slightly less likely to receive invasive therapies as well as evidence-based medical therapies in the hospital and at discharge, and while CLD was shown to provide independent predictive value for mortality in patients with non-STEMI, it was not independently associated with mortality in STEMI patients, possibly due to the higher rates of reperfusion therapy and evidence-based medical therapies these patients received.

"Special attention to clinical surveillance for bleeding events, selection and dosing of anticoagulant and antiplatelet therapies, and consideration of radial access during cardiac catheterization may be prudent in this high-risk subgroup for the prevention and management of bleeding complications," add the authors.

Keywords: Shock, Cardiogenic, Registries, Hospital Mortality, Erythrocyte Transfusion, Cardiac Catheterization, Heart Failure, Hemorrhage, United States, Lung Diseases

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