Acute COPD exacerbations carry increased risk of myocardial infarction, pulmonary embolism

Patients with chronic obstructive pulmonary disease (COPD) are at heightened risk of myocardial infarction (MI) and pulmonary embolism (PE) in the presence of acute exacerbations, according to a study.

Researchers used data from the Swedish National Airway Register and identified a cohort of 66,422 patients at least 30 years of age (mean age 70.3 years, 43.9 percent male, mean BMI 26.9 kg/m²) who had a primary diagnosis of COPD and complete data on lung function. The mean FEV₁ percent predicted was 60.3. Of the patients, 37.6 percent had active tobacco use, 77.2 percent used bronchodilation therapy, and 50.2 percent used inhaled corticosteroids (ICSs).

In the 1-year period before the index date, 13.0 percent of patients had one moderate acute exacerbation of COPD, 8.8 percent had at least two moderate, 5.8 percent had one severe, and 1.3 percent had at least two severe.

Competing risk regression according to the Fine-Gray model showed that the long-term risk of both MI and PE increased commensurate with the number and severity of acute COPD exacerbations relative to the absence of such exacerbations. The subdistribution hazard ratios for MI and PE ranged from between 1.10 (95 percent confidence interval [CI], 0.97–1.24) and 1.33 (95 percent CI, 1.11–1.60) for patients with one moderate exacerbation to between 1.82 (95 percent CI, 1.36–2.44) and 2.62 (95 percent CI, 1.77–3.89) among patients with at least two severe exacerbations.

Time-restricted sensitivity analysis indicated that the associations were stronger during the first year of follow-up and diminished over time.