Stroke, MI Risk Increased After Severe COPD Exacerbations

Acute exacerbations of chronic obstructive pulmonary disease (COPD) were associated with an increased risk for myocardial infarction (MI) and ischemic stroke within 28 days of onset, according to the results of a self-controlled case-series that used data from the UK Clinical Practice Research Datalink with linked Hospital Episodes Statistics data.

Findings from the analysis were published in Annals of the American Thoracic Society.

The investigators sought to quantify the elevated risk for MI and ischemic stroke linked with both moderate and severe COPD exacerbations and to explore those factors that might modify these risks. In this study, the rates of MI and ischemic stroke following acute COPD exacerbations were compared with stable time.  A total of 2 groups of adult participants with COPD were included in the study: 2850 individuals who experienced a first MI and ≥1 acute COPD exacerbation during the study period and 3466 individuals who experienced a first ischemic stroke and ≥1 acute COPD exacerbation during the study period. Overall, 164 participants with COPD were included in both analyses.

Compared with stable periods, the 91 days following an acute CODP exacerbation were associated with a 65% increased risk for MI (incidence rate ratio [IRR], 1.65; 95% CI, 1.50-1.81) and a 51% increased risk for ischemic stroke (IRR, 1.51; 95% CI, 1.39-1.65). This elevated risk peaked in the initial 3 days after onset of an acute COPD exacerbation for MI and seemed to peak in the 4 to 7 days following the onset of an acute COPD exacerbation for ischemic stroke. This risk returned to stable period levels after 28 days for MI but remained elevated longer in individuals who experienced ischemic stroke.

The use of aspirin vs not using aspirin was associated with a lower risk for ischemic stroke (IRR, 1.28; 95% CI, 1.10-1.50 vs IRR, 1.63; 95% CI, 1.47-1.80, respectively), but not for MI.

The investigators concluded that the increased risk for acute vascular events following acute COPD exacerbations was significantly higher in individuals with severe compared with moderate COPD exacerbations. Patient characteristics linked with these elevated risks include Global Initiative for COPD stage of airflow limitation, angina, atrial fibrillation, use of respiratory medications, use of cardiovascular medications at baseline, and the number of exacerbations experienced during the previous year.

Disclosures: Funding for this study was provided by GlaxoSmithKline and the MRC.

Reference

Rothnie KJ, Connell O, Müllerová H, et al. Myocardial infarction and ischaemic stroke following exacerbations of chronic obstructive pulmonary disease [published online May 3, 2018]. Ann Am Thorac Soc. doi:10.1513/AnnalsATS.201710-815OC