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Interactions between COPD and outcomes after percutaneous coronary intervention
Tomas Konecny1, Krishen Somers, Marek Orban
1Mayo Clinic, Rochester, MN, USA.
Insights
Patients with chronic obstructive pulmonary disease (COPD) face higher mortality and myocardial infarction (MI) risks after percutaneous coronary intervention (PCI). COPD severity significantly worsens these outcomes, highlighting the need for risk stratification.
Area of Science:
- Cardiology
- Pulmonology
- Public Health
Background:
- Chronic obstructive pulmonary disease (COPD) is prevalent in patients undergoing percutaneous coronary intervention (PCI).
- Limited research exists on COPD's impact on PCI outcomes.
- The influence of COPD severity on post-PCI prognosis remains unexamined.
Purpose of the Study:
- To investigate the association between COPD and outcomes following PCI.
- To determine if COPD severity affects mortality and major adverse cardiac events after PCI.
Main Methods:
- Retrospective analysis of 14,346 patients from the Mayo Clinic PCI registry.
- COPD identification using ICD-9 codes and pulmonary function test (PFT) results.
- Comparison of outcomes between COPD and non-COPD cohorts.
Main Results:
- Patients with COPD (n=2,001) had significantly higher rates of all-cause mortality, cardiac mortality, and myocardial infarction (MI) compared to those without COPD (n=12,345).
- Increased COPD severity correlated with higher mortality post-PCI.
- COPD presence and severity were independent risk factors for mortality and MI after PCI.
Conclusions:
- COPD significantly increases long-term mortality, cardiac mortality, and MI risk in PCI patients.
- Worse COPD severity, indicated by PFTs, is linked to reduced post-PCI survival.
- Screening for COPD in PCI candidates can improve risk stratification and guide targeted therapies.
Background:
COPD is common in patients undergoing percutaneous coronary intervention (PCI), but its association with outcomes following PCI has received only limited study. The effects of COPD severity on outcomes after PCI are not known.
Methods:
We conducted a retrospective cross-sectional analysis of prospectively acquired data in 14,346 consecutive patients enrolled in the Mayo Clinic PCI registry. Patients with COPD were identified by International Classification of Diseases, 9th edition, coding and pulmonary function test (PFT) results. Outcomes of COPD vs non-COPD cohorts were compared.
Results:
The COPD group included 2,001 patients (72% men) aged 70 +/- 10 years, and the non-COPD group included 12,345 patients (70% men) aged 66 +/- 12 years. In the follow-up period after PCI (median, 4.1 years; interquartile range, 1.9-7.0 years), the patients with COPD experienced a significantly higher incidence of all-cause mortality (P < .0001), cardiac mortality (P < .0001), and myocardial infarction (MI) (P < .0001) than the patients without COPD. Additionally, severity of COPD was associated with increased mortality after PCI (P < .0001). In a multivariate analysis, COPD presence and severity remained significant risk factors for mortality (P < .0001), cardiac mortality (P < .0001), and occurrence of MI after PCI (P < .0001).
Conclusions:
COPD is associated with significantly increased overall long-term mortality, cardiac mortality, and occurrence of MI in patients undergoing PCI. Increasing severity of COPD as measured by PFT is associated with decreased survival after PCI. 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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