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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)
Author(s) -
Hawkins Nathaniel M.,
Huang Zhen,
Pieper Karen S.,
Solomon Scott D.,
Kober Lars,
Velazquez Eric J.,
Swedberg Karl,
Pfeffer Marc A.,
McMurray John J.V.,
Maggioni Aldo P.
Publication year - 2009
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1093/eurjhf/hfp001
Subject(s) - medicine , myocardial infarction , hazard ratio , cardiology , heart failure , proportional hazards model , confidence interval
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.