Acute coronary syndrome after an infective exacerbation of COPD: a prospective cohort study of acute lower respiratory tract disease in hospitalised adults.

Introduction: Comorbid cardiovascular disease has been reported extensively in community COPD populations, but to a lesser degree in acute hospital settings. Shared risk factors and acute infection both increase acute coronary syndrome (ACS) risk. Our objective is to assess a cohort of adults hospitalised for an acute lower respiratory tract infection (aLRTI) to determine whether COPD status is an independent risk factor for ACS. Methods: A prospective observational cohort study of adults aged ≥40 years (n=8496) with community-acquired aLRTI (Bristol, UK) was conducted between 27 July 2020 and 28 November 2022. Cases included physician diagnosis of COPD; controls were aLRTI without COPD. Outcomes included physician-diagnosed ACS occurring within 30 days of admission. Logistic regression models were adjusted for shared cardiovascular risk factors and aLRTI severity. Results: 30-day ACS events in patients hospitalised with aLRTI with COPD were 7.59% (190 out of 2502), Conclusions: In this large, real-world cohort of hospitalised adults with aLRTI, 30-day ACS event rates were high at ∼7-13%. A diagnosis of COPD even in the absence of pneumonia increases ACS risk