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Background  Acute myocardial infarction is a major cause of hospitalization and death in patients with chronic obstructive pulmonary disease ( COPD ); however, temporal trends in the management and clinical outcomes of these patients remain unclear.    Methods and Results  We conducted an observational study by using a representative sample of 1 million beneficiaries from the Taiwan National Health Insurance Research Database. Comorbidities, in‐hospital treatment, and outcomes were compared for patients with acute myocardial infarction with and without  COPD  between 2004 and 2013. Temporal trends in treatment and outcomes were analyzed. We included 6770 patients admitted to hospitals with acute myocardial infarction diagnoses, of whom 1921 (28.3%) had  COPD . Fewer patients with  COPD  received β‐blockers (adjusted odds ratio 0.66, 95% CI 0.59–0.74), angiotensin‐converting enzyme inhibitors/angiotensin  II  receptor blockers (adjusted odds ratio 0.83, 95%  CI  0.73–0.93), statins, anticoagulants, dual antiplatelets, and coronary interventions. These patients had higher mortality (in hospital: adjusted hazard ratio 1.25 [95% CI 1.11–1.41]; 1 year: adjusted hazard ratio 1.20 [95% CI 1.09–1.32]) and respiratory failure risk during admission. Temporal trends showed little improvement in mortality in patients with  COPD  over 10 years. Multivariable logistic regression indicated that dual antiplatelets, β‐blockers, angiotensin‐converting enzyme inhibitors/angiotensin  II  receptor blockers, statins, coronary angiography, and coronary artery bypass grafting surgery were significantly correlated with improved mortality in patients with COPD.    Conclusions  In Taiwan, a lower proportion of patients with  COPD  received evidence‐based therapies for acute myocardial infarction than did patients without  COPD , and their clinical outcomes were inferior. Limited improvement in mortality was observed over the preceding 10 years and is attributable to the underuse of evidence‐based treatments.

journal of the american heart association

Temporal Trends in Treatment and Outcomes of Acute Myocardial Infarction in Patients With Chronic Obstructive Pulmonary Disease: A Nationwide Population‐Based Observational Study