The frequency, characteristics and outcomes of acute myocardial infarction (AMI) during exacerbation of chronic obstructive pulmonary disease (COPD) are unknown. Adult patients hospitalized with a principle diagnosis of acute COPD exacerbation were identified using retrospective analysis of the Nationwide Inpatient Sample (NIS) from 2003 to 2016. Patients were stratified into 2-groups with and without a secondary diagnosis of AMI. The study’s endpoints were in-hospital morbidity, mortality, and resource utilization. We also assessed the impact of invasive management strategy on the same end-points. We included 6 894 712 hospitalizations, of which 56 515 (0.82%) were complicated with AMIs. Patients with AMI were older, and had higher prevalence of known coronary disease (48.9% vs. 27.4%), atrial fibrillation (23.3% vs. 15.2%), heart failure (47.8% vs. 26.2%), and anemia (20.7% vs. 14.8%) (p < 0.001). Rates of oxygen dependence were similar (16.3% vs. 16.1%, p = 0.24). In 56 486 propensity-matched pairs of patients with and without AMI, mortality was higher in the AMI group (12.1% vs. 2.1%, p < 0.001). Rates of major morbidities, non-home discharge, and cost were all higher in the AMI group. A minority (18.1%) of patients with AMI underwent invasive assessment, and those had lower in-hospital mortality before (4.9% vs. 13.8%) and after (5.0% vs. 10.0%) propensity-score matching (p < 0.001). This lower mortality persisted in a sensitivity analysis accounting for immortal time bias. AMI complicates ∼1% of patients admitted with acute COPD exacerbation, and those have worse outcomes than those without AMI. Invasive management for secondary AMI during acute COPD exacerbation may be associated with improved outcomes but is utilized in <20% of patients.

慢性阻塞性肺疾病（COPD）加重期间急性心肌梗死（AMI）的发生频率，特征和结局尚不清楚。使用回顾性分析，从2003年至2016年对全国住院患者样本（NIS）进行回顾性分析，确定了以急性COPD急性加重为主要诊断原则住院的成年患者。将患者分为2组，有和没有AMI的二次诊断。该研究的终点是医院内的发病率，死亡率和资源利用情况。我们还评估了侵入性管理策略对相同端点的影响。我们纳入了6 894 712例住院治疗，其中56 515例（0.82％）患有AMI。AMI患者年龄较大，已知冠状动脉疾病的患病率更高（48.9％比27.4％），房颤（23.3％比15.2％），心力衰竭（47。p  <0.001）。氧依赖率相似（16.3％对16.1％，p  = 0.24）。在有和没有AMI的56 486名倾向匹配的患者中，AMI组的死亡率更高（12.1％对2.1％，p  <0.001）。AMI组的主要发病率，非家庭出院率和费用均较高。少数（18.1％）AMI患者接受了侵入性评估，在倾向评分匹配之前（4.9％vs. 13.8％）和之后（5.0％vs. 10.0％）的院内死亡率较低（p <0.001）。这种较低的死亡率在敏感性分析中持续存在，说明了不朽的时间偏差。AMI使急性COPD恶化患者的约1％复杂化，其结果比无AMI的患者差。急性COPD急性发作期间对继发性AMI的侵入性治疗可能与改善预后相关，但在<20％的患者中得到了利用。