• Tadahiro Goto, Yuichi J Shimada, Mohammad Kamal Faridi, Carlos A Camargo, and Kohei Hasegawa.
• Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA. tag695@mail.harvard.edu.
• J Gen Intern Med. 2018 Sep 1; 33 (9): 1461-1468.

BackgroundThere is a lack of comprehensive view of the association between acute exacerbation of COPD (AECOPD) and the risk of acute cardiovascular events.ObjectiveTo determine the association of AECOPD with 30-day and 1-year incidences of acute cardiovascular event.DesignSelf-controlled case series analysis using population-based datasets from three US states from 2005 through 2011.ParticipantsPatients aged ≥ 40 years with AECOPD.Main MeasuresThe primary outcome was a composite of an ED visit or hospitalization for acute cardiovascular events, including acute myocardial infarction, heart failure, atrial fibrillation, pulmonary embolism, and stroke. We compared the incidence of each patient's acute cardiovascular event during the first 30-day period before the index AECOPD (30-day reference period) in comparison with that during the 30-day period after the index AECOPD. Likewise, with the 1-year period before the index AECOPD as reference, we also estimated incidence rate ratios (IRRs) for each patient's outcomes during 1-year period after the index AECOPD.Key ResultsOverall, there were 362,867 patients with an ED visit or hospitalization for AECOPD. Compared with the 30-day reference period, the incidence of acute cardiovascular event in the 30-day period after the AECOPD was significantly higher (IRR, 1.34; 95%CI, 1.30-1.39; P < 0.001). Likewise, compared with the 1-year reference period, the incidence during the 1-year period after the AECOPD was also higher (IRR, 1.20; 95%CI, 1.18-1.22; P < 0.001). For each of acute cardiovascular conditions, the associations remained significant (all P < 0.05).ConclusionsAECOPD was associated with increased 30-day and 1-year incidences of acute cardiovascular event.

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