COPD increases cardiac mortality in patients presenting with ventricular tachyarrhythmias and aborted cardiac arrest

Area of Science:

• Cardiology
• Pulmonology
• Critical Care Medicine

Background:

• Limited data exists on the outcomes of patients with chronic obstructive pulmonary disease (COPD) who present with ventricular tachyarrhythmias and sudden cardiac arrest (SCA).
• Understanding the prognostic impact of COPD in this high-risk population is crucial for clinical management and risk stratification.

Purpose of the Study:

• To assess the prognostic impact of chronic obstructive pulmonary disease (COPD) in patients presenting with ventricular tachyarrhythmias and sudden cardiac arrest (SCA) upon admission.
• To compare the long-term outcomes of patients with and without COPD in this specific clinical scenario.

Main Methods:

• A retrospective analysis of a large registry including consecutive patients with ventricular tachycardia (VT), fibrillation (VF), and SCA from 2002 to 2016.
• Comparison of patients with COPD versus those without COPD using multivariable Cox regression and propensity-score matching.
• Primary endpoint: long-term all-cause mortality at 2 years. Secondary endpoints included short-term mortality, cardiac death, rehospitalization, and a composite endpoint of adverse cardiac events within 2 years.

Main Results:

• In 2813 high-risk patients, 9% had COPD. Ventricular fibrillation (VF) was less common in COPD patients (28% vs. 39%).
• COPD was significantly associated with increased long-term all-cause mortality (HR=1.245; p=0.001), confirmed by propensity score matching.
• Patients with COPD exhibited higher rates of short-term mortality, cardiac death at 24 hours, and a composite endpoint including cardiac death, ventricular tachyarrhythmia recurrence, and appropriate ICD therapies within 2 years (p < 0.033).

Conclusions:

• In high-risk patients with ventricular tachyarrhythmias and SCA, COPD is a significant independent predictor of adverse outcomes.
• COPD is associated with substantially higher long-term all-cause mortality, 24-hour cardiac death, and a composite of major adverse cardiac events within two years.
• These findings underscore the importance of considering COPD status in risk stratification and management strategies for patients experiencing life-threatening ventricular arrhythmias.