Risk of myocardial infarction (MI) and death following MI in people with chronic obstructive pulmonary disease (COPD): a systematic review and meta-analysis

Kieran J Rothnie, Ruoling Yan, Liam Smeeth, Jennifer K Quint, Kieran J Rothnie, Ruoling Yan, Liam Smeeth, Jennifer K Quint

Abstract

Objectives: Cardiovascular disease is an important comorbidity in patients with chronic obstructive pulmonary disease (COPD). We aimed to systematically review the evidence for: (1) risk of myocardial infarction (MI) in people with COPD; (2) risk of MI associated with acute exacerbation of COPD (AECOPD); (3) risk of death after MI in people with COPD.

Design: Systematic review and meta-analysis.

Methods: MEDLINE, EMBASE and SCI were searched up to January 2015. Two reviewers screened abstracts and full text records, extracted data and assessed studies for risk of bias. We used the generic inverse variance method to pool effect estimates, where possible. Evidence was synthesised in a narrative review where meta-analysis was not possible.

Results: Searches yielded 8362 records, and 24 observational studies were included. Meta-analysis showed increased risk of MI associated with COPD (HR 1.72, 95% CI 1.22 to 2.42) for cohort analyses, but not in case-control studies: OR 1.18 (0.80 to 1.76). Both included studies that investigated the risk of MI associated with AECOPD found an increased risk of MI after AECOPD (incidence rate ratios, IRR 2.27, 1.10 to 4.70, and IRR 13.04, 1.71 to 99.7). Meta-analysis showed weak evidence for increased risk of death for patients with COPD in hospital after MI (OR 1.13, 0.97 to 1.31). However, meta-analysis showed an increased risk of death after MI for patients with COPD during follow-up (HR 1.26, 1.13 to 1.40).

Conclusions: There is good evidence that COPD is associated with increased risk of MI; however, it is unclear to what extent this association is due to smoking status. There is some evidence that the risk of MI is higher during AECOPD than stable periods. There is poor evidence that COPD is associated with increased in hospital mortality after an MI, and good evidence that longer term mortality is higher for patients with COPD after an MI.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Figures

Figure 1
Figure 1
Study selection. AECOPD, acute exacerbation of COPD; COPD, chronic obstructive pulmonary disease; MI, myocardial infarction.
Figure 2
Figure 2
Summary of risk of bias for risk assessments for: A studies investigating risk of MI associated with COPD; B studies investigating risk of MI associated with AECOPD; and C studies investigating risk of death following MI in people with COPD. AECOPD, acute exacerbation of COPD; COPD, chronic obstructive pulmonary disease; MI, myocardial infarction.
Figure 3
Figure 3
Forest plot showing risk of MI associated with COPD in cohort studies which adjusted for smoking status. CIs may vary slightly from those quoted in tables due to transformation during meta-analysis. COPD, chronic obstructive pulmonary disease; MI, myocardial infarction.
Figure 4
Figure 4
Forest plot showing risk of MI associated with COPD in case-control studies which are adjusted for smoking status. CIs may vary slightly from those quoted in tables due to transformation during meta-analysis. COPD, chronic obstructive pulmonary disease; MI, myocardial infarction.
Figure 5
Figure 5
Forest plot showing risk of MI associated with COPD in cohort studies which did not adjust for smoking status. CIs may vary slightly from those quoted in tables due to transformation during meta-analysis. COPD, chronic obstructive pulmonary disease; MI, myocardial infarction.
Figure 6
Figure 6
Forest plot showing risk of MI associated with acute exacerbations of COPD. CIs may vary slightly from those quoted in tables due to transformation during meta-analysis. COPD, chronic obstructive pulmonary disease; MI, myocardial infarction.
Figure 7
Figure 7
Forest plot showing risk of in-hospital death following MI for patients with COPD compared to patients without COPD. CIs may vary slightly from those quoted in tables due to transformation during meta-analysis. COPD, chronic obstructive pulmonary disease; MI, myocardial infarction.
Figure 8
Figure 8
Forest plot showing risk of death after discharge following MI for patients with COPD compared to patients without COPD. Cis may vary slightly from those quoted in tables due to transformation during meta-analysis. COPD, chronic obstructive pulmonary disease; MI, myocardial infarction.

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