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Published on: January 28, 2020
Underdiagnosis and prognosis of chronic obstructive pulmonary disease after percutaneous coronary intervention: a
Pere Almagro1, Anna Lapuente2, Julia Pareja1
1Department of Internal Medicine, Mutua de Terrassa University Hospital, Terrassa, Spain.
Insights
Chronic obstructive pulmonary disease (COPD) is highly prevalent and underdiagnosed in patients with ischemic heart disease (IHD) undergoing percutaneous coronary intervention (PCI). Undiagnosed COPD independently increases mortality and cardiovascular events post-PCI.
Area of Science:
- Cardiology
- Pulmonology
- Medical Prognostics
Background:
- Retrospective studies suggest poorer prognosis for ischemic heart disease (IHD) and chronic obstructive pulmonary disease (COPD) patients post-percutaneous coronary intervention (PCI).
- The prognostic impact of undiagnosed COPD in IHD patients undergoing PCI remains unknown.
Purpose of the Study:
- To evaluate the prognostic impact of previously diagnosed or newly diagnosed COPD in patients with IHD treated with PCI.
Main Methods:
- Consecutive inclusion of IHD patients confirmed by PCI.
- Post-PCI spirometry and cardiovascular risk factor evaluation.
- Analysis of all-cause mortality, new cardiovascular events, and combined endpoints.
Main Results:
- 24.8% of 133 IHD patients met spirometric criteria for COPD, with 81.8% undiagnosed.
- COPD patients were older, had more affected coronary vessels, and a history of myocardial infarction.
- COPD was associated with significantly greater mortality (HR: 8.85) and cardiovascular events (HR: 1.87) post-PCI, even in previously undiagnosed cases. These findings persisted after adjustment.
Conclusions:
- High prevalence and underdiagnosis of COPD exist in IHD patients undergoing PCI.
- COPD is an independent predictor of increased mortality and cardiovascular events in this population during follow-up.
Background:
Retrospective studies based on clinical data and without spirometric confirmation suggest a poorer prognosis of patients with ischemic heart disease (IHD) and chronic obstructive pulmonary disease (COPD) following percutaneous coronary intervention (PCI). The impact of undiagnosed COPD in these patients is unknown. We aimed to evaluate the prognostic impact of COPD - previously or newly diagnosed - in patients with IHD treated with PCI.
Methods:
Patients with IHD confirmed by PCI were consecutively included. After PCI they underwent forced spirometry and evaluation for cardiovascular risk factors. All-cause mortality, new cardiovascular events, and their combined endpoint were analyzed.
Results:
A total of 133 patients (78%) male, with a mean (SD) age of 63 (10.12) years were included. Of these, 33 (24.8%) met the spirometric criteria for COPD, of whom 81.8% were undiagnosed. IHD patients with COPD were older, had more coronary vessels affected, and a greater history of previous myocardial infarction. Median follow-up was 934 days (interquartile range [25%-75%]: 546-1,160). COPD patients had greater mortality (P=0.008; hazard ratio [HR]: 8.85; 95% confidence interval [CI]: 1.76-44.47) and number of cardiovascular events (P=0.024; HR: 1.87; 95% CI: 1.04-3.33), even those without a previous diagnosis of COPD (P=0.01; HR: 1.78; 95% CI: 1.12-2.83). These differences remained after adjustment for sex, age, number of coronary vessels affected, and previous myocardial infarction (P=0.025; HR: 1.83; 95% CI: 1.08-3.1).
Conclusion:
Prevalence and underdiagnosis of COPD in patients with IHD who undergo PCI are both high. These patients have an independent greater mortality and a higher number of cardiovascular events during follow-up.
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