P813Chronic obstructive pulmonary disease is associated with higher mortality from ST-segment elevation myocardial infarction but not from non ST-segment elevation myocardial infarction

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Background: Chronic obstructive pulmonary disease (COPD) is associated with higher mortality from cardiovascular diseases. Limited data are available about the association between the diagnosis of COPD and outcomes of different types of myocardial infarction (MI). Methods: In a retrospective cohort study, using the 2014 Nationwide Inpatient Sample (NIS), we analyzed adult patients with Non ST-Segment Elevation Myocardial Infarction (NSTEMI) and ST-Segment Elevation Myocardial Infarction (STEMI), who had diagnosis of COPD. The goal of our study was to determine if COPD affects outcomes of different types of MI. We adjusted our results for potential confounders including age, sex, race, hospital location, hospital teaching status, insurance type, hospital bed size and the Charlson Comorbidity Index. Results: We identified 171395 patients with diagnosis of STEMI and 432985 with diagnosis of NSTEMI, who were further divided into subpopulations with and without COPD. In the NSTEMI COPD group (n=58940) percentage of females was the same as in non-COPD group (41%) and patients were younger (mean age 68 and 70 years respectively). In the STEMI COPD group (n=17460) more patients were female (37%) than in non-COPD group (30%) and patient were older (mean age 67 and 63 years respectively). COPD was associated with higher mortality in STEMI (OR=1.3, 95% CI=1.16–1.47) but not in NSTEMI group. STEMI patients were also at higher risk of cardiac arrest (OR=1.23, 95% CI= 1.08–1.4). Both groups had increased risk of mechanical ventilation, more pronounced for STEMI (OR=1.35, 95% CI=1.21=1.51) than NSTEMI (OR=1.23, 95% CI=1.12–1.34). NSTEMI patients were at lower risk for dialysis due to acute kidney injury (AKI) (OR= 0.56, 95% CI=0.44–0.72). COPD was also associated with increased total charges from length of stay in NSTEMI patients (Coef.= 1613.83 95% CI= 49.62- 3178.04). In both groups COPD was not associated with risk of shock, Bilevel Positive Pressure ventilation and mechanical circulatory support as well as with length of stay.

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