High prevalence of undiagnosed COPD among patients evaluated for suspected myocardial ischaemia
Andreas Jönsson1,2, Artur Fedorowski1,3, Gunnar Engström1
1Department of Clinical Sciences, Lund University, Malmö, Sweden.
Insights
Undiagnosed chronic obstructive pulmonary disease (COPD) is common in patients evaluated for coronary artery disease (CAD). Symptoms of COPD and CAD overlap, highlighting the need for spirometry testing in these patients, particularly smokers.
Area of Science:
- Cardiology
- Pulmonology
- Internal Medicine
Background:
- Coronary artery disease (CAD) and chronic obstructive pulmonary disease (COPD) are leading global causes of death.
- COPD is often overlooked in patients undergoing cardiac evaluations, despite its high comorbidity with CAD.
Purpose of the Study:
- To determine the prevalence of undiagnosed COPD in outpatients evaluated for suspected myocardial ischemia.
- To compare the prevalence of undiagnosed COPD with that of reversible myocardial ischemia.
Main Methods:
- Spirometry was performed on 433 outpatients referred for myocardial perfusion imaging due to suspected stable myocardial ischemia.
- 400 subjects without a prior COPD diagnosis were analyzed, comparing COPD prevalence using GOLD and LLN criteria against reversible myocardial ischemia.
Main Results:
- Undiagnosed COPD was found in 33.5% (GOLD criteria) or 11.5% (LLN criteria) of patients.
- Reversible myocardial ischemia was present in 13.8% of patients.
- Presenting symptoms did not differ between COPD, myocardial ischemia, and normal findings, with smoking history being a key factor for COPD.
Conclusions:
- Undiagnosed COPD is as prevalent as reversible myocardial ischemia in middle-aged outpatients evaluated for suspected myocardial ischemia.
- Presenting symptoms are not reliable for differentiating between COPD and myocardial ischemia.
- Additional COPD testing, especially spirometry, is recommended for patients undergoing coronary ischemia evaluation, particularly smokers.
Objective:
Chronic obstructive pulmonary disease (COPD) and coronary artery disease (CAD) are leading causes of global morbidity and mortality. Despite the well-known comorbidity between COPD and CAD, the presence of COPD may be overlooked in patients undergoing coronary evaluation. We aimed to assess the prevalence of undiagnosed COPD among outpatients evaluated due to suspected myocardial ischemia.
Methods:
Among 500 outpatients who were referred to myocardial perfusion imaging due to suspected stable myocardial ischaemia, 433 patients performed spirometry. Of these, a total of 400 subjects (age 66 years; 45% women) had no previous COPD diagnosis and were included in the current study. We compared the prevalence of previously undiagnosed COPD according to spirometry criteria from The Global Initiative for Chronic Obstructive Lung Disease (GOLD) or lower limit of normal (LLN) and reversible myocardial ischaemia according to symptoms and clinical factors.
Results:
A total of 134 (GOLD criteria; 33.5 %) or 46 patients (LLN criteria; 11.5%) had previously undiagnosed COPD, whereas 55 patients (13.8 %) had reversible myocardial ischaemia. The presenting symptoms (chest discomfort, dyspnoea) did not differ between COPD, myocardial ischaemia and normal findings. Except for smoking, no clinical factors were consistently associated with previously undiagnosed COPD.
Conclusions:
Among middle-aged outpatients evaluated due to suspected myocardial ischaemia, previously undiagnosed COPD is at least as common as reversible myocardial ischaemia and the presenting symptoms do not differentiate between these entities. Patients going through a coronary ischaemia evaluation should be additionally tested for COPD, especially if there is a positive history of smoking.
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