Assessing Disparities in Long Term Outcomes in Non-ST Elevation Myocardial Infarction According to Presence of Obstructive Airways Disease

Acute myocardial infarction is a major cause of mortality in individuals with obstructive airway disease. The impact of inpatient care quality following non-ST elevation myocardial infarction (NSTEMI) on long-term mortality among those with chronic obstructive pulmonary disease (COPD) and asthma remains poorly understood. We analysed 499 318 adults with NSTEMI from the Myocardial Ischaemia National Audit Project registry between 2005 and 2019, linked with Hospital Episode Statistics for airway disease diagnosis and Office for National Statistics data for mortality outcomes. Inpatient care quality was measured using the opportunity-based quality-indicator (OBQI) score. Long-term outcomes were evaluated using multivariable Cox regression and Kaplan-Meier analyses. Individuals with COPD and asthma received lower quality of care (OBQI score: no airways disease: 83.5 vs COPD: 78.1, asthma: 80.8, P < .001). Percutaneous coronary intervention was less frequent in COPD patients (22%) than in those without airway disease (30%) or with asthma (31%), P < .001. COPD was associated with higher 10-year mortality (hazard ratio [HR]: 1.58, 95% CI 1.56-1.60), whereas those with asthma had lower risk (HR: 0.97, 95% CI 0.95-0.98). COPD was associated with increased adjusted cardiovascular mortality (sub-distribution HR: 1.89, 95% CI 1.84-1.95). Individuals with COPD received lower-quality inpatient care and fewer coronary interventions, which was associated with higher long-term mortality.