The risk of myocardial infarction (MI) and death following MI in people with chronic obstructive pulmonary disease: A systematic review and meta-analysis
File(s)
Published version
Author(s)
Rothnie, KJ
Yan, R
Smeeth, L
Quint, JK
Type
Journal Article
Abstract
Objectives Cardiovascular disease is an important co-morbidity in COPD patients. We aimed to systematically review the evidence for: i) risk of MI in people with COPD; ii) risk of MI associated with AECOPD; iii) risk of death after MI in people with COPD.
Design Systematic review and meta-analysis.
Methods MEDLINE, EMBASE and SCI were searched up to January 2015. Two reviewers screened abstracts and full text records, extracted data and assessed studies for risk of bias. We used the generic inverse variance method to pool effect estimates where possible. Evidence was synthesised in a narrative review where meta-analysis was not possible.
Results Searches yielded 8362 records, and 24 observational studies were included. Meta-analysis showed increased risk of MI associated with COPD (HR 1.72, 95% CI 1.22-2.42) for cohort analyses, but not in case-control studies OR 1.18 (0.80-1.76). Both included studies that investigated the risk of MI associated with AECOPD found an increased risk of MI after AECOPD (IRR 2.27, 1.10-4.70, and IRR 13.04, 1.71-99.7). Meta-analysis showed weak evidence for increased risk of death for COPD patients in-hospital after MI (OR 1.13, 0.97-1.31). However meta-analysis showed an increased risk of death after MI for COPD patients during follow-up (HR 1.26, 1.13-1.40).
Conclusions There is good evidence that COPD is associated with increased risk of MI, however it is unclear to what extent this association is due to smoking status. There is some evidence that the risk of MI is higher during AECOPD than stable periods. There is poor evidence that COPD is associated with increased in-hospital mortality after an MI, and good evidence that longer term mortality is higher for COPD patients after an MI.
Design Systematic review and meta-analysis.
Methods MEDLINE, EMBASE and SCI were searched up to January 2015. Two reviewers screened abstracts and full text records, extracted data and assessed studies for risk of bias. We used the generic inverse variance method to pool effect estimates where possible. Evidence was synthesised in a narrative review where meta-analysis was not possible.
Results Searches yielded 8362 records, and 24 observational studies were included. Meta-analysis showed increased risk of MI associated with COPD (HR 1.72, 95% CI 1.22-2.42) for cohort analyses, but not in case-control studies OR 1.18 (0.80-1.76). Both included studies that investigated the risk of MI associated with AECOPD found an increased risk of MI after AECOPD (IRR 2.27, 1.10-4.70, and IRR 13.04, 1.71-99.7). Meta-analysis showed weak evidence for increased risk of death for COPD patients in-hospital after MI (OR 1.13, 0.97-1.31). However meta-analysis showed an increased risk of death after MI for COPD patients during follow-up (HR 1.26, 1.13-1.40).
Conclusions There is good evidence that COPD is associated with increased risk of MI, however it is unclear to what extent this association is due to smoking status. There is some evidence that the risk of MI is higher during AECOPD than stable periods. There is poor evidence that COPD is associated with increased in-hospital mortality after an MI, and good evidence that longer term mortality is higher for COPD patients after an MI.
Date Issued
2015-09-11
Date Acceptance
2015-06-17
Citation
BMJ Open, 2015, 5
ISSN
2044-6055
Publisher
BMJ Publishing Group
Journal / Book Title
BMJ Open
Volume
5
Copyright Statement
This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/
License URL
Publication Status
Published
Article Number
e007824