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Prognostic Value of Impaired Spirometry in Patients with Myocardial Infarction : A Longitudinal Study of Two European Cohorts

Sundh, Josefin ; Parker, William A.E. ; Oldgren, Jonas ; Andell, Pontus LU ; Reitan, Christian LU ; Jernberg, Tomas ; Hofmann, Robin ; Mohammad, Moman A. LU orcid ; Erlinge, David LU orcid and Åkerblom, Axel , et al. (2026) In International Journal of COPD 21.
Abstract

Purpose: 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... (More)

Purpose: 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.

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type
Contribution to journal
publication status
published
subject
keywords
acute ischemic cardiovascular events, chronic obstructive pulmonary disease, COPD, MACE, major adverse cardiovascular events, obstructive pattern, preserved ratio impaired spirometry, PRISm
in
International Journal of COPD
volume
21
article number
580301
publisher
Dove Medical Press Ltd.
external identifiers
  • pmid:41947782
  • scopus:105035088349
ISSN
1176-9106
DOI
10.2147/COPD.S580301
language
English
LU publication?
yes
additional info
Publisher Copyright: © 2026 Sundh et al.
id
a4b8447c-4f16-42c1-a4f7-28481e9f6e88
date added to LUP
2026-06-22 16:20:11
date last changed
2026-09-16 04:41:05
@article{a4b8447c-4f16-42c1-a4f7-28481e9f6e88,
  abstract     = {{<p>Purpose: 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<sup>®</sup> COPD-6 device was used to assess the ratio of forced expiratory volume in 1 and 6 seconds (FEV<sub>1</sub>/FEV<sub>6</sub>) and FEV<sub>1</sub> as a percentage of the predicted value (FEV<sub>1</sub>%pred). Obstructive pattern was defined as FEV<sub>1</sub>/FEV<sub>6</sub> &lt;0.7, PRISm as FEV<sub>1</sub>/FEV<sub>6</sub> &gt;0.7 and FEV<sub>1</sub>%pred &lt;80, and normal findings as FEV<sub>1</sub>/FEV<sub>6</sub> ≥0.7 and FEV<sub>1</sub>%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.</p>}},
  author       = {{Sundh, Josefin and Parker, William A.E. and Oldgren, Jonas and Andell, Pontus and Reitan, Christian and Jernberg, Tomas and Hofmann, Robin and Mohammad, Moman A. and Erlinge, David and Åkerblom, Axel and Sederholm Lawesson, Sofia and Konstantinidis, Kyriakos V. and Lindbäck, Johan and Janson, Christer and Björkenheim, Anna and Elamin, Nadir and McMellon, Hannah and Moyle, Bethany and Patel, Mehul and El Khoury, Jad and Surujbally, Raulin and James, Stefan and Storey, Robert F.}},
  issn         = {{1176-9106}},
  keywords     = {{acute ischemic cardiovascular events; chronic obstructive pulmonary disease; COPD; MACE; major adverse cardiovascular events; obstructive pattern; preserved ratio impaired spirometry; PRISm}},
  language     = {{eng}},
  publisher    = {{Dove Medical Press Ltd.}},
  series       = {{International Journal of COPD}},
  title        = {{Prognostic Value of Impaired Spirometry in Patients with Myocardial Infarction : A Longitudinal Study of Two European Cohorts}},
  url          = {{http://dx.doi.org/10.2147/COPD.S580301}},
  doi          = {{10.2147/COPD.S580301}},
  volume       = {{21}},
  year         = {{2026}},
}