COPD linked to poorer outcomes after PCI
: Patients who have undergone percutaneous coronary intervention (PCI) are at increased risk for long-term all-cause mortality, cardiac mortality, and myocardial infarction (MI) if they also suffer from chronic obstructive pulmonary disease (COPD), study results show.
"COPD has been associated with increased overall mortality and with increased cardiovascular mortality both in the general population and in patients with coronary artery disease (CAD) undergoing coronary bypass grafting," write Charanjit Rihal (Mayo Clinic, Rochester, Minnesota, USA) and team in the journal Chest.
However, they add that "the prognostic effect of COPD on patients with CAD undergoing PCI has received only limited study."
To investigate further, the researchers studied data on 14,346 patients who had undergone PCI at the Mayo Clinic.
Of these patients, 2001 (72% men), aged an average of 70 years, met criteria for a diagnosis of COPD at the time of PCI and 12,345 (70% men), aged an average of 66 years, did not.
At the 5-year follow-up, 83% of patients without COPD were alive versus 68% of patients with the respiratory disorder, and this difference widened at the 10-year follow-up to 68% and 39%, respectively.
Furthermore, at the 5-year follow-up, cardiac death had occurred in 7.7% of patients without COPD versus 14.0% of those with the condition, while 13.2% and 18.9%, respectively, had suffered an MI by this time.
After accounting for age, gender, hypercholesterolemia, hypertension, diabetes mellitus, current smoking, and other factors, COPD remained an independent risk factor for all-cause mortality (odds ratio [OR]=1.79), cardiac mortality (OR=1.57), and MI (OR=1.30).
Rihal and team conclude: "COPD is associated with significantly increased overall long-term mortality, cardiac mortality, and occurrence of MI in patients undergoing PCI."
They add: "Screening for COPD in patients undergoing PCI could contribute importantly to risk stratification, identifying patients needing closer follow-up and optimizing targeted therapeutic interventions."
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By Mark Cowen