Chronic obstructive pulmonary disease after myocardial infarction in the community

Background: Myocardial infarction (MI) and chronic obstructive pulmonary disease (COPD) are frequent and share common risk factors. Yet, studies on MI patients reported limited and conflicting results on the prevalence of COPD, its impact on outcome, and how these may have changed over time. We examined, in a geographically defined community, the prevalence of COPD in patients with MI, its impact on mortality, and how these associations changed over time. Methods: Residents of Olmsted County, Minnesota, who experienced an MI meeting standardized criteria from 1979 to 2007 were included (3,438, 42% women, mean age 68 ± 15 years). Chronic obstructive pulmonary disease was ascertained from the medical records. Results: Of 3,438 patients, 415 (12%) had COPD. During the study, COPD prevalence increased from 7% in 1979-1985 to 15% in 2000-2007 (P < .001). Survival was worse in patients with COPD than in those without COPD (5-year survival rate: 46% [95% CI 41%-52%] vs 68% [95% CI 66%-70%], respectively; P < .01). The association between COPD and death was independent of age and risk factors (adjusted hazard ratio 1.30, 95% CI 1.10-1.54, P < .01) and did not change over time. Conclusions: In a large community of patients with MI, the prevalence of COPD increased over time and was associated with a markedly increased risk of death after MI independently of age, risk factors, and comorbidity. This underscores the importance of this condition and the need to optimize care for these high-risk patients.