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Presentation, management and mortality after a first MI in people with and without asthma: A study using UK MINAP data

Asthma has been associated with a higher incidence of myocardial infarction (MI), higher prevalence of MI risk factors and higher burden of cardiovascular diseases. However, detailed associations between the presentation and initial management at the time of MI and post-MI outcomes in people with as...

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Autores principales: Pinto, Paulo, Rothnie, Kieran J, Lui, Kelvin, Timmis, Adam, Smeeth, Liam, Quint, Jennifer K
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5802653/
https://www.ncbi.nlm.nih.gov/pubmed/28393591
http://dx.doi.org/10.1177/1479972317702140
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author Pinto, Paulo
Rothnie, Kieran J
Lui, Kelvin
Timmis, Adam
Smeeth, Liam
Quint, Jennifer K
author_facet Pinto, Paulo
Rothnie, Kieran J
Lui, Kelvin
Timmis, Adam
Smeeth, Liam
Quint, Jennifer K
author_sort Pinto, Paulo
collection PubMed
description Asthma has been associated with a higher incidence of myocardial infarction (MI), higher prevalence of MI risk factors and higher burden of cardiovascular diseases. However, detailed associations between the presentation and initial management at the time of MI and post-MI outcomes in people with asthma compared to the general population have not been studied. A total of 300,161 people were identified with a first MI over the period 2003–2013 in the Myocardial Ischaemia National Audit Project database, of whom 8922 (3%) had asthma. Logistic regression was used to compare presentation, in-hospital care, in-hospital and 180-day post-discharge all-cause mortality in people with and without asthma adjusting for demographics and comorbidities, diagnosis on arrival and secondary prevention. People with asthma were more likely to have a delay in their MI diagnosis following an STEMI (ST-elevation myocardial infarction; odds ratio (OR) 1.38, confidence interval CI 1.06–1.79) but not an nSTEMI (non-ST-elevation myocardial infarction; OR 1.04, CI 0.92–1.17) compared to people without asthma and a delay in reperfusion (OR 1.19, CI 1.09–1.30) following an STEMI. They were much less likely to be discharged on a beta blocker following an STEMI or nSTEMI (OR 0.24, CI 0.21–0.28 and OR 0.27, CI 0.24–0.30, respectively). There was no difference in in-hospital or 180-day mortality (OR 0.98, CI 0.59–1.62 and OR 0.99, CI 0.72–1.36) following an STEMI or nSTEMI (OR 0.89, CI 0.47–1.68 and OR 1.05, CI 0.85–1.28). Although people with asthma were more likely to have a delay in diagnosis following an STEMI but not an nSTEMI compared to the general population, were more likely to have a delay in reperfusion therapy and were much less likely to receive beta blockers following an STEMI or nSTEMI, there was no difference in the prescriptions of other secondary prevention medications. None of the differences in presentation or management were associated with an increase in all-cause in-hospital or 180-day mortality in people with asthma compared to the general population.
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spelling pubmed-58026532018-02-12 Presentation, management and mortality after a first MI in people with and without asthma: A study using UK MINAP data Pinto, Paulo Rothnie, Kieran J Lui, Kelvin Timmis, Adam Smeeth, Liam Quint, Jennifer K Chron Respir Dis Original Papers Asthma has been associated with a higher incidence of myocardial infarction (MI), higher prevalence of MI risk factors and higher burden of cardiovascular diseases. However, detailed associations between the presentation and initial management at the time of MI and post-MI outcomes in people with asthma compared to the general population have not been studied. A total of 300,161 people were identified with a first MI over the period 2003–2013 in the Myocardial Ischaemia National Audit Project database, of whom 8922 (3%) had asthma. Logistic regression was used to compare presentation, in-hospital care, in-hospital and 180-day post-discharge all-cause mortality in people with and without asthma adjusting for demographics and comorbidities, diagnosis on arrival and secondary prevention. People with asthma were more likely to have a delay in their MI diagnosis following an STEMI (ST-elevation myocardial infarction; odds ratio (OR) 1.38, confidence interval CI 1.06–1.79) but not an nSTEMI (non-ST-elevation myocardial infarction; OR 1.04, CI 0.92–1.17) compared to people without asthma and a delay in reperfusion (OR 1.19, CI 1.09–1.30) following an STEMI. They were much less likely to be discharged on a beta blocker following an STEMI or nSTEMI (OR 0.24, CI 0.21–0.28 and OR 0.27, CI 0.24–0.30, respectively). There was no difference in in-hospital or 180-day mortality (OR 0.98, CI 0.59–1.62 and OR 0.99, CI 0.72–1.36) following an STEMI or nSTEMI (OR 0.89, CI 0.47–1.68 and OR 1.05, CI 0.85–1.28). Although people with asthma were more likely to have a delay in diagnosis following an STEMI but not an nSTEMI compared to the general population, were more likely to have a delay in reperfusion therapy and were much less likely to receive beta blockers following an STEMI or nSTEMI, there was no difference in the prescriptions of other secondary prevention medications. None of the differences in presentation or management were associated with an increase in all-cause in-hospital or 180-day mortality in people with asthma compared to the general population. SAGE Publications 2017-04-10 2018-02 /pmc/articles/PMC5802653/ /pubmed/28393591 http://dx.doi.org/10.1177/1479972317702140 Text en © The Author(s) 2017 http://creativecommons.org/licenses/by/3.0/ This article is distributed under the terms of the Creative Commons Attribution 3.0 License (http://www.creativecommons.org/licenses/by/3.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Original Papers
Pinto, Paulo
Rothnie, Kieran J
Lui, Kelvin
Timmis, Adam
Smeeth, Liam
Quint, Jennifer K
Presentation, management and mortality after a first MI in people with and without asthma: A study using UK MINAP data
title Presentation, management and mortality after a first MI in people with and without asthma: A study using UK MINAP data
title_full Presentation, management and mortality after a first MI in people with and without asthma: A study using UK MINAP data
title_fullStr Presentation, management and mortality after a first MI in people with and without asthma: A study using UK MINAP data
title_full_unstemmed Presentation, management and mortality after a first MI in people with and without asthma: A study using UK MINAP data
title_short Presentation, management and mortality after a first MI in people with and without asthma: A study using UK MINAP data
title_sort presentation, management and mortality after a first mi in people with and without asthma: a study using uk minap data
topic Original Papers
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5802653/
https://www.ncbi.nlm.nih.gov/pubmed/28393591
http://dx.doi.org/10.1177/1479972317702140
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