Changing Clinical Presentation of Acute Coronary Syndrome in Patients With Chronic Obstructive Pulmonary Disease
Objective: to determine clinical features of acute coronary syndrome (ACS) in patients with chronic obstructive pulmonary disease (COPD). Methods. We included into this study 272 patients with ACS, 110 with and 162 without concomitant COPD. In both groups we registered prevalence of atypical forms of ACS debut, severity of acute heart failure (Killip class), time from symptoms onset prior to percutaneous coronary intervention (PCI), as well as the prevalence of cardiac arrhythmias. Results. Demographic characteristics and presence of comorbidities did not differ between patients with and without COPD. Clinical course of ACS in patients with COPD was characterized by: higher frequency of atypical forms of ACS debut (30.0% vs 14.8%, p=0,0.04) including its asthmatic variant (15.5% vs 6.8%, p=0.026), higher Killip class (p=0.025), higher relative risk of atrial fibrillation (AF) (RR 2.06; 95% confidence interval 1.14-3.74). Atypical variants of ACS debut were associated with increased symptoms onset - PCI time (p<0.001). Conclusion: Concomitant COPD was associated with increased likelihood of atypical ACS debut, paroxysmal AF, more severe acute heart failure, and prolongation of time to invasive treatment.