Inhaled corticosteroid/long-acting bronchodilator treatment mitigates STEMI clinical presentation in COPD patients

Marco Contoli, Gianluca Campo, Rita Pavasini, Irene Marchi, Alessia Pauletti, Cristina Balla, Antonio Spanevello, Roberto Ferrari, Alberto Papi

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Patients with myocardial infarction and concomitant COPD are at increased risk of poor clinical outcomes, including death, as compared to patients without COPD.

AIM: To investigate and compare the severity of the clinical presentation of ST-segment elevation myocardial infarction (STEMI) and of the short-(7days) and long-term-(end of follow up) mortality in COPD patients treated with inhaled corticosteroids (ICS)/long-acting bronchodilator (LABD) - either long-acting beta2 agonist (LABA) or long-acting muscarinic antagonist (LAMA) - vs. any other inhaled treatments.

METHODS: Data from the REAL (Registro Angioplastiche dell'Emilia-Romagna) Registry were obtained from a large prospective study population of 11,118 patients admitted to hospital for STEMI.

RESULTS: From January 2003 to June 2009 we identified 2032 COPD patients admitted to hospital for STEMI. Eight hundred and twenty (40%) COPD patients were on ICS/LABD treatment (of which 55% on ICS/LABA) prior to admission. After adjustment for potential confounding factors, ICS/LABD treatment before STEMI was an independent predictor of reduced risk of pulmonary oedema and cardiogenic shock (OR 0.5, 95%CI 0.3-0.72, p<0.01; OR 0.7, 95%CI 0.4-0.9, p=0.03, respectively). ICS/LABD treatment was associated to reduced 7-days mortality (OR 0.54, 95%CI 0.29-0.98, p=0.045) compared to other inhaled regimens. ICS/LABD-treated did not affect long-term (median 4years) mortality. After hospital discharge, the proportion of ICS/LABD treated patients decreased significantly at 6months and afterwards after the STEMI episode.

CONCLUSION: Our data provide preliminary evidence that in COPD patients ICS/LABD treatment reduces the severity of STEMI acute-phase clinical manifestations compared to other inhaled treatments.

Original languageEnglish
Pages (from-to)82-86
Number of pages5
JournalEuropean Journal of Internal Medicine
Volume47
DOIs
Publication statusPublished - Jan 2018

Keywords

  • Administration, Inhalation
  • Adrenal Cortex Hormones/therapeutic use
  • Aged
  • Aged, 80 and over
  • Bronchodilator Agents/therapeutic use
  • Drug Therapy, Combination
  • Female
  • Humans
  • Italy/epidemiology
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Proportional Hazards Models
  • Prospective Studies
  • Pulmonary Disease, Chronic Obstructive/complications
  • ST Elevation Myocardial Infarction/drug therapy
  • Severity of Illness Index

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