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Background Patients with COPD are at increased risk of myocardial infarction (MI) compared to the general population and have shorter survival after any MI. We investigated whether this held true in patients with an "unanticipated" MI, defined as an MI occurring as the first manifestation of atherosclerotic disease and without any traditional cardiovascular risk factors and without any prior chest pain. Methods All patients experiencing their first MI between 1st January 2003 and 31st December 2008 as recorded in Myocardial Ischaemia National Audit Project (MINAP), who had no previous evidence of MI in their General Practice Research Database (GPRD) or MINAP record were included. Patients under 18 years of age, not registered with GPRD at the time of MI, or with <1 year of standard follow-up before their MI were excluded. Data were provided by the "Cardiovascular Disease Research Linking Bespoke Cohorts and Electronic Records" (CALIBER) group at UCL. The primary exposure of interest was diagnosis of COPD (defined in GPRD) and the outcome death after MI. Survival analysis was done using Kaplan-Meier methods. Cox proportional hazards models were used to adjust for potential confounders (age and sex). Results 8065 individuals were included, 968 (12%) of whom had a physician diagnosis of COPD made either before the first MI or during the follow-up period. 87 patients died on the day of admission 10 (11.5%) of whom had COPD. The overall mortality rate was 160.2 deaths (95%CI 145.5 to 176.5) per 1000 person years in those with COPD compared to 99.4 deaths (95.2 to 103.9) per 1000 person years in those without COPD. After adjusting for confounding by sex and stratifying for age, survival was shorter after 1st MI in patients with COPD; HR 1.37 (1.23 to 1.52, p<0.001) in those with COPD compared to those without COPD (Abstract S96 figure 1). Survival was shorter in those (n=96) who exacerbated within 6 months of their 1st MI; HR 1.72 (1.13 to 2.60, p=0.01). Conclusions Survival is shorter after an "unanticipated" MI in patients with COPD and patients who exacerbate within 6 months of their MI have an even higher mortality rate. [ABSTRACT FROM AUTHOR]

The article discusses a study to determine whetherß blockers are associated with decreased mortality in patients with chronic obstructive pulmonary disease (COPD) having a first myocardial infarction. Patients with COPD with a first myocardial infarction from January 1, 2003 to December 31, 2008 was recorded. It indicates thatßblockers initiated upon admission for myocardial infarction were associated with substantial survival benefits.

Context: While the effects of weather and, in particular, ambient temperature on overall mortality are well documented, the strength of the evidence base for the effects on acute myocardial infarction (MI) are less clear. Objective: To systematically review studies specifically focusing on the effects of temperature on MI. Data sources: Medline, Embase, and GeoBase publication databases, as well as reference lists, and the websites of a number of relevant public organisations. Study selection: Studies of original data in which ambient temperature was an exposure of interest and MI a specific outcome were selected. Data extraction: The reported effects of ambient temperature on the risk of MI, including effect sizes and confidence intervals, where possible, were recorded. Methodological details were also extracted, including study population, location and setting, ascertainment of MI events, adjustment for potential confounders and consideration of lagged effects. Results: 19 studies were identified, of which 14 considered the short-term effects of temperature on a daily timescale, the remainder looking at longer-term effects. Overall, 8 of the 12 studies which included relevant data from the winter season reported a statistically significant short-term increased risk of MI at lower temperatures, while increases in risk at higher temperatures were reported in 7 of the 13 studies with relevant data. A number of differences were identified between studies in the population included demographics, location, local climate, study design and statistical methodology. Conclusion: A number of studies, including some that were large and relatively well controlled, suggested that both hot and cold weather had detrimental effects on the short-term risk of MI. However, further research with consistent methodology is needed to clarify the magnitude of these effects and to show which populations and individuals are vulnerable. [ABSTRACT FROM AUTHOR]

Context: Short-term fluctuations in air pollution have been associated with changes in both overall and cardiovascular mortality. Objective: To consider the effects of air pollution on myocardial infarction (MI) risk by systematically reviewing studies looking at this specific outcome. Data sources: Medline, Embase and TOXNET publication databases, as well as reference lists and the websites of relevant public organisations. Study selection: Studies presenting original data with MI as a specific outcome and one or more of the following as an exposure of interest were included: particulate matter (PM), black carbon/black smoke, ozone, carbon monoxide, nitrogen oxides, sulphur dioxide and traffic exposure. Data extraction: The effects of each pollutant on risk of MI, including effect sizes and confidence intervals, were recorded where possible. Methodological details were also extracted including study population, location and setting, ascertainment of MI events, adjustment for potential confounders and consideration of lagged effects. Results: 26 studies were identified: 19 looked at the short-term effects of pollution on a daily timescale; the remaining 7 at longer-term effects. A proportion of studies reported statistically significant detrimental effects of PM with diameter <2.5 μm (3/5 studies, risk increase estimates ranging from 5 to 17% per 10 μg/m3 increase), PM <10 μm (3/10, 0.7-11% per 10 μg/m3), CO (6/14, 2-4% per ppm), SO2 (6/13, effect estimates on varied scales) and NO2 (6/13, 1-9% per 10 ppb). Increasing ozone levels were associated with a reduction in MI risk in 3/12 studies. A number of differences in location, population and demographics and study methodology between studies were identified that might have affected results. Conclusion: There is some evidence that short-term fluctuations in air pollution affect the risk of MI. However, further studies are needed to clarify the nature of these effects and identify vulnerable populations and individuals. [ABSTRACT FROM AUTHOR]