Prognostic Value of Impaired Spirometry in Patients with Myocardial Infarction: A Longitudinal Study of Two European Cohorts
Year: 2026
Type: article
Study design: Observational Study
Abstract: Josefin Sundh,1,* William AE Parker,2,3,* Jonas Oldgren,4,5 Pontus Andell,6 Christian Reitan,7 Tomas Jernberg,7 Robin Hofmann,8 Moman A Mohammad,9 David Erlinge,9 Axel Åkerblom,4,5 Sofia Sederholm Lawesson,10 Kyriakos V Konstantinidis,11 Johan Lindbäck,5 Christer Janson,4 Anna Björkenheim,12 Nadir Elamin,2,3 Hannah McMellon,2,3 Bethany Moyle,2,3 Mehul Patel,13 Jad El Khoury,14 Raulin Surujbally,15 Stefan James,4,5,* Robert F Storey2,3,* 1Department of Respiratory Medicine, Örebro University Hospital; Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro, Sweden; 2Cardiovascular Research Unit, Division of Clinical Medicine, University of Sheffield, Sheffield, UK; 3NIHR Sheffield Biomedical Research Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK; 4Department of Medical Sciences, Uppsala University, Uppsala, Sweden; 5Uppsala Clinical Research Centre, Uppsala University, Uppsala, Sweden; 6Department of Physiology and Pharmacology, Karolinska Institutet, and ME Cardiology, Karolinska University Hospital, Stockholm, Sweden; 7Department of Clinical Science, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden; 8Department of Clinical Science and Education, Division of Cardiology, Karolinska Institutet, Stockholm, Sweden; 9Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden; 10Clinical Department of Cardiology, Region Östergötland and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; 11Global Project, Respiratory and Immunology, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK; 12Department of Cardiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; 13Clinical Development, Respiratory and Immunology, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK; 14Global Medical Affairs, Global Medical Affairs, Cardiovascular, Renal & Metabolic Disease, BioPharmaceuticals Medical, AstraZeneca, Cambridge, UK; 15Global Clinical Operations, Respiratory and Immunology, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK*These authors contributed equally to this workCorrespondence: Josefin Sundh, Department of Respiratory Medicine, Örebro University Hospital, Örebro, Sweden, Email [email protected]: The study aimed to investigate the associations between impaired spirometry such as obstructive pattern and preserved ratio impaired spirometry (PRISm) and occurrent cardiovascular events and deaths in patients with acute myocardial infarction.Patients and Methods: Cohort study of 517 patients with age ≥ 40 years and ≥ 10 pack-years of smoking, hospitalized for myocardial infarction at eight sites in Sweden and the United Kingdom. The Vitalograph® COPD-6 device was used to assess the ratio of forced expiratory volume in 1 and 6 seconds (FEV1/FEV6) and FEV1 as a percentage of the predicted value (FEV1%pred). Obstructive pattern was defined as FEV1/FEV6 < 0.7, PRISm as FEV1/FEV6 > 0.7 and FEV1%pred < 80, and normal findings as FEV1/FEV6 ≥ 0.7 and FEV1%pred ≥ 80. Follow-up data were obtained from national registers or follow-up visits. Multivariable Cox regression was used to analyze the associations of obstructive pattern and PRISm with the incidence of acute ischemic cardiovascular events or major adverse cardiovascular events (MACE), respectively, within one year.Results: Obstructive pattern was found in 95 (18%), PRISm in 192 (37%) and normal spirometry in 230 (45%) patients. A cardiovascular event occurred in 21 (4%) and MACE in 28 (5%). Compared with normal spirometry, PRISm was independently associated with both new cardiovascular events (HR (95% CI) 3.44 (1.07– 11.0)) and MACE (4.94 (1.63 to 15.0)), and obstructive pattern with MACE (3.87 (1.08– 13.8)). Further adjustment for cardiac or COPD treatment did not substantially change the results.Conclusion: About half of patients with acute myocardial infarction and a ≥ 10 pack-year smoking history have abnormal spirometry findings. Both obstructive pattern and PRISm are independently associated with increased risk for MACE within one year. We suggest that spirometry should be considered as a routine assessment in patients with smoking history and recent myocardial infarction.Plain Language Summary: Impaired spirometry such as obstructive pattern as in chronic obstructive pulmonary disease (COPD) and preserved ratio impaired spirometry (PRISm) are associated with increased risk of mortality in the general populationThe present study investigated the prevalence and associations of obstructive pattern and PRISm with and occurrent cardiovascular events and deaths in patients with acute myocardial infarction, in cohorts from Sweden and the United KingdomWe found that about half of patients with acute myocardial infarction and a ≥ 10 pack-year smoking history have abnormal spirometry findingsIn patients with acute myocardial infarction and a ≥ 10 pack-year smoking history, obstructive pattern and PRISm are both associated with increased one-year risk of occurrent acute ischemic cardiovascular events and cardiovascular deathsKeywords: chronic obstructive pulmonary disease, COPD, obstructive pattern, preserved ratio impaired spirometry, PRISm, acute ischemic cardiovascular events, major adverse cardiovascular events, MACE
Institutions: Linköping University, Region Östergötland
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7152335945
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