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The association between recent hospitalized COPD exacerbations and adverse outcomes after percutaneous coronary
Wei-Chieh Lin1, Chang-Wen Chen1, Chin-Li Lu2,3
1Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Insights
Patients with chronic obstructive pulmonary disease (COPD) face higher risks after percutaneous coronary intervention (PCI). Recent COPD exacerbations significantly increase mortality and adverse cardiovascular events post-PCI.
Area of Science:
- Cardiology
- Pulmonology
- Public Health
Background:
- Chronic obstructive pulmonary disease (COPD) is a significant comorbidity in patients with coronary artery disease.
- COPD exacerbations represent critical events that can impact overall patient health.
- The specific influence of recent hospitalized COPD exacerbations on percutaneous coronary intervention (PCI) outcomes requires further investigation.
Purpose of the Study:
- To investigate the association between COPD and outcomes following PCI.
- To determine the impact of recent hospitalized COPD exacerbations on mortality and adverse cardiovascular events after PCI.
Main Methods:
- A retrospective cohort study using Taiwan's National Health Insurance Research Database.
- Inclusion of 215,275 adult patients undergoing first-time PCI (2000-2012), with 15,485 diagnosed with COPD.
- Analysis of risks for hospital mortality, overall mortality, and major adverse cardiac and cerebrovascular events (MACCEs) in relation to COPD and recent exacerbations.
Main Results:
- COPD independently increased risks of hospital mortality, overall mortality, ischemic events, cerebrovascular events, and MACCE post-PCI.
- Recent hospitalized exacerbations in COPD patients further elevated risks of overall mortality, ischemic events, and MACCE.
- A trend of higher adverse event risks was observed with more frequent or recent exacerbations, particularly ≥2 within a year or any within a month prior to PCI.
Conclusions:
- COPD is linked to poorer outcomes after PCI, including increased mortality and cardiovascular events.
- Recent hospitalized exacerbations exacerbate these risks, highlighting a vulnerable patient subgroup.
- Integrated care strategies are crucial to mitigate COPD-related morbidity and mortality post-PCI, especially for patients with recent exacerbations.
Purpose:
COPD is associated with coronary artery disease, and exacerbations are major events in COPD. However, the impact of recent hospitalized exacerbations on outcomes of percutaneous coronary intervention (PCI) remains underdetermined.
Patients And Methods:
Using the National Health Insurance Research Database of Taiwan, we identified 215,275 adult patients who underwent first-time PCI between 2000 and 2012. Among these patients, 15,485 patients had COPD. The risks of hospital mortality, overall mortality, and adverse cardiovascular outcomes after PCI (ie, ischemic events, repeat revascularization, cerebrovascular events, and major adverse cardiac and cerebrovascular events [MACCEs]) in relation to COPD, and the frequency and timing of recent hospitalized exacerbations within 1 year before PCI were estimated.
Results:
COPD was independently associated with increased risks of hospital mortality, overall mortality, ischemic events, cerebrovascular events, and MACCE during follow-up after PCI. Among cerebrovascular events, ischemic rather than hemorrhagic stroke was more likely to occur. In COPD patients, recent hospitalized exacerbations further increased the risks of overall mortality, ischemic events, and MACCE following PCI. Notably, patients with more frequent or more recent hospitalized exacerbations had a trend toward higher risks of these adverse events (all P-values for trend <0.0001), especially those with ≥2 exacerbations within 1 year or any exacerbation within 1 month before PCI.
Conclusion:
Integrated care is urgently needed to alleviate COPD-related morbidity and mortality after PCI, especially for patients with a recent hospitalized exacerbation.
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