COPD Exacerbations Tied to Increased Risks for Patients Who Also Have CAD

Allison Inserro

A recent study looking at the impact of recent exacerbations of chronic obstructive pulmonary disease (COPD) on hospitalized patients who also have coronary artery disease found that COPD was was independently associated with additional risks of complications after percutaneous coronary intervention (PCI).

The authors said integrated care is urgently needed to reduce COPD-related morbidity and mortality after PCI, especially for patients with a recent hospitalized exacerbation. Cardiovascular disease accounts for approximately one-third of deaths overall in patients with COPD, the study said.

Researchers used the National Health Insurance Research Database of Taiwan and identified 215,275 adult patients who underwent first-time PCI between 2000 and 2012. The risks of hospital mortality, overall mortality, and adverse cardiovascular outcomes after PCI, such as ischemic events, repeat revascularization, cerebrovascular events, and major adverse cardiac and cerebrovascular events (MACCEs), in relation to COPD were estimated. Researchers also examined the frequency and timing of recent hospitalized exacerbations within 1 year before PCI.

Among these patients, 15,485 patients had COPD. Of the 199,790 patients who did not have COPD, the mean age was 64.7 years. The male-to-female ratio was 2.56. The mean total hospital costs were equivalent to approximately $5382.

Patients with COPD were significantly older, with a male-to-female ratio of 3.05, and they frequently had multiple comorbidities. These patients were less likely to undergo PCI at the occurrence of acute coronary syndrome compared with the control group and were also less likely to receive coronary stenting during PCI. For patients with COPD, the PCI procedures were less likely to be conducted in medical centers, but the hospital costs were significantly higher than those of the control group.

COPD was independently associated with increased risks of hospital mortality, overall mortality, ischemic events, cerebrovascular events, and MACCE during follow-up after PCI, after adjustment for potential confounding variables (adjusted OR for mortality, 1.13; 95% CI, 1.03-1.23; P = .01).

Among cerebrovascular events, ischemic rather than hemorrhagic stroke was more likely to occur. Although COPD was not associated with repeat revascularization, it appeared to mildly increase the risk of repeat PCI.

Patients with more frequent or more recent hospitalized exacerbations had a trend toward higher risks of these adverse events (all values for trend <.0001), especially those with 2 or more exacerbations within 1 year or any exacerbation within 1 month before PCI.

Lin WC, Chen CW, Lu, CL, et al. The association between recent hospitalized COPD exacerbations and adverse outcomes after percutaneous coronary intervention: a nationwide cohort study [published online January 3, 2019]. Int J Chron Obstruct Pulmon Dis. doi: 10.2147/COPD.S187345.
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