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[Lung Hyperinflation in Chronic Obstructive Pulmonary Disease and Long-Term Outcomes of Percutaneous Coronary
V K Zafiraki1, E D Kosmachyeva1, L V Shulzhenko1
1Federal State Budgetary Educational Institution of Higher Education "Kuban State Medical University" of the Ministry of Health of the Russian Federation.
Insights
Lung hyperinflation in COPD patients undergoing PCI is linked to worse long-term cardiac outcomes. This includes higher rates of cardiac death, myocardial infarction, and stroke, highlighting a critical interaction between respiratory and cardiovascular health.
Area of Science:
- Cardiology
- Pulmonology
- Internal Medicine
Background:
- Chronic Obstructive Pulmonary Disease (COPD) is a major public health concern.
- Percutaneous Coronary Intervention (PCI) is a common procedure for stable ischemic heart disease.
- Lung hyperinflation (LHI) is a characteristic feature of COPD, but its impact on PCI outcomes is not well understood.
Purpose of the Study:
- To investigate the effect of LHI in COPD patients on long-term outcomes following PCI.
- To compare the incidence of major adverse cardiac events (MACE) between COPD patients with and without LHI undergoing PCI.
Main Methods:
- A prospective cohort study included 135 patients with COPD and stable ischemic heart disease who underwent PCI.
- Patients were categorized into groups with (n=60) and without LHI (n=75).
- Outcomes assessed included MACE (cardiac death, myocardial infarction, stroke, repeat revascularization) over a 3-year follow-up, analyzed using Kaplan-Meier curves.
Main Results:
- While overall MACE rates showed a trend towards significance (p=0.097), Kaplan-Meier curves revealed a statistically significant difference (p=0.04) in long-term outcomes between groups.
- Patients with LHI experienced significantly higher rates of cardiac death, myocardial infarction, and stroke (21.7% vs. 8.0%, p=0.027).
- Higher plasma levels of high-sensitivity C-reactive protein (hsCRP) were observed in patients with LHI, correlating more closely with functional residual capacity than with forced expiratory volume in 1 second.
Conclusions:
- LHI in COPD patients undergoing PCI is associated with significantly worse long-term cardiovascular outcomes, primarily driven by increased cardiac death, myocardial infarction, and stroke.
- Elevated hsCRP levels may play a role in the heightened cardiovascular risk observed in these patients.
- These findings underscore the importance of considering pulmonary status in the management of cardiac patients with COPD.
Objective:
to assess the effect of lung hyperinflation (LHI) in patients with chronic obstructive pulmonary disease (COPD) on longterm outcomes of percutaneous coronary intervention (PCI).
Materials And Methods:
Patients with COPD who suffered stable ischemic heart disease and underwent PCI (n=135) were included in a prospective cohort study. LHI was found in 60 patients, while 75 patients had no LHI. Evaluation included comparing the frequency of major adverse cardiac events (MACE) (cardiac death, myocardial infarcпункtion [MI], stroke, repeat revascularization) and Kaplan-Mayer curves between groups of patients with and without LHI. Associations of parameters of pulmonary function and plasma levels of high sensitivity C-reactive protein (hsCRP) with occurrence of MACE were also elucidated. Duration of follow-up was up to 3 years (median 20 months).
Results:
Study groups did not differ significantly by main factors of cardiovascular risk, except plasma level of hsCRP. MACE occurred in 41.7 and 26.7 % of patients in groups with and without LHI, respectively (p=0.097). However, divergence of the Kaplan-Meier curves was statistically significant (p=0.04). The main contribution was made by cardiac death, MI and stroke (21.7 and 8.0 % among patients with and without LHI; p=0.027). No difference was found regarding repeat revascularization. The correlation between functional residual lung capacity and plasma level of hsCRP was closer than the correlation between forced expiratory volume in 1 second and hsCRP level (r=0.36 and r=0.19; p.
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