Key result
Very severe airflow obstruction is linked to a ~5-fold higher post-MI five-year mortality in COPD.
Why the study?
Although COPD is associated with worse outcomes after AMI, the prognostic value of objective pulmonary function has not been well characterized.
Does more severe airflow obstruction predict higher five-year all-cause mortality in post-AMI patients with COPD?
Cohort (n=169)
No
Does more severe airflow obstruction predict higher five-year all-cause mortality in post-AMI patients with COPD?
Hazard Ratio: 5.23 (95% CI 1.62–16.89)
Absolute Event Rate: 70.8% vs 19%
p-value: p=0.006
In patients with COPD surviving an AMI, more severe airflow obstruction is associated with a substantially higher risk of five-year all-cause mortality, highlighting the need for integrated cardiopulmonary follow-up.
Background: Chronic obstructive pulmonary disease (COPD) and acute myocardial infarction (AMI) frequently coexist and share several biological pathways and risk factors. Although COPD is associated with worse outcomes after AMI, the prognostic value of objective pulmonary function has not been well characterized. The aim of this study was to evaluate the association between airflow-obstruction severity and five-year all-cause mortality after AMI among patients with COPD. Methods: This single-center retrospective cohort study was restricted to adult post-AMI patients (2002–2017) with a background diagnosis of COPD and documented spirometry; therefore, the final cohort represents a selected subgroup of the source COPD-AMI population. Airflow obstruction was categorized according to forced expiratory volume in one second (FEV1) as Mild, Moderate, Severe, or Very Severe (according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD)). The outcome was all-cause mortality during up to five years of follow-up. Results: Among 1594 patients hospitalized with AMI and a COPD diagnosis, 169 patients with available spirometry were included in this selected analytical cohort (mean age 66.76 ± 9.86 years, 76.9% male). During follow-up, 65 patients died, corresponding to an overall five-year mortality rate of 38.5%. Mortality increased progressively across obstruction categories: 19.0%, 33.3%, 40.0%, and 70.8% in Mild, Moderate, Severe, and Very Severe, respectively (p for trend <0.001). In multivariable analysis, adjusted hazard ratios for mortality were: 2.49 (95% CI 0.86–7.24), 3.38 (95% CI 1.09–10.46), and 5.23 (95% CI 1.62–16.89) for Moderate, Severe, and Very Severe, compared with Mild obstruction. Conclusions: Among patients with COPD who survived hospitalization for AMI, more severe airflow obstruction was associated with substantially higher five-year all-cause mortality. These findings support the potential role of spirometry-based risk stratification and highlight the need for integrated cardiopulmonary follow-up after AMI.
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Shashar et al. (2026) conducted a cohort in Acute Myocardial Infarction and Chronic Obstructive Pulmonary Disease (n=169). Very severe airflow obstruction (FEV1 < 30%) vs. Mild airflow obstruction (FEV1 ≥80%) was evaluated on Five-year all-cause mortality (HR 5.23, 95% CI 1.62-16.89, p=0.006). Among patients with COPD who survived an acute myocardial infarction, very severe airflow obstruction was associated with a significantly higher risk of five-year all-cause mortality compared to mild obstruction (HR 5.23).
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