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Signal Acquisition, Score Interpretation, and Economics of a Non-Invasive Point-of-Care Test for Coronary Artery Disease
Published on: August 9, 2024
Current symptom-based risk scores for stable coronary artery disease evaluation are not applicable in COPD patients
Christoph Beyer1, Alex Pizzini2, Anna Boehm2
1Dept of Internal Medicine III - Cardiology and Angiology, Medical University Innsbruck, Innsbruck, Austria.
Insights
Patients with Chronic Obstructive Pulmonary Disease (COPD) experience significant delays in coronary artery disease (CAD) evaluation due to overlapping symptoms. Current risk scores are inadequate for this population.
Area of Science:
- Pulmonary Medicine
- Cardiology
- Diagnostic Imaging
Background:
- Cardiovascular diseases are a major comorbidity in patients with Chronic Obstructive Pulmonary Disease (COPD).
- Coronary Artery Disease (CAD) is more prevalent in COPD patients, yet dedicated diagnostic guidelines are lacking.
- Overlapping symptoms between COPD and CAD complicate primary evaluation.
Purpose of the Study:
- To investigate the adequacy of primary evaluation for Coronary Artery Disease (CAD) in patients with Chronic Obstructive Pulmonary Disease (COPD).
- To assess symptom presentation and referral delays for invasive coronary angiography (ICA) in COPD patients compared to controls.
- To determine the clinical outcomes and revascularization rates in COPD patients undergoing ICA.
Main Methods:
- Retrospective matching of 302 COPD patients with 302 non-COPD controls undergoing invasive coronary angiography (ICA).
- Documentation of symptom quality and onset, calculation of pretest probabilities using European Society of Cardiology (ESC) guidelines.
- Comparison of delay to ICA referral and clinical outcomes, including revascularization.
Main Results:
- COPD patients experienced a significantly longer delay to ICA referral (19.9 months) compared to controls (8.3 months).
- COPD patients presented less frequently with typical chest pain and more often with dyspnea alone.
- A trend for increased delay in ICA referral was observed with increasing COPD severity (GOLD grades).
- Prevalence of significant CAD (>70% stenosis) was 35.3%; revascularization rates decreased in COPD patients with higher pretest probability.
Conclusions:
- Patients with COPD are inadequately evaluated for Coronary Artery Disease (CAD) due to symptom overlap.
- Existing risk assessment tools for stable chest pain are not suitable for COPD patients.
- Improved diagnostic strategies are needed for timely CAD evaluation in the COPD population.
Background:
Cardiovascular diseases are arguably the most important comorbidity in patients with COPD. Despite an increased prevalence of coronary artery disease (CAD) in COPD patients, there are no dedicated diagnostic recommendations.
Objectives:
We investigated whether COPD patients receive adequate primary evaluation of CAD despite overlapping symptoms.
Methods:
In total, 302 patients with COPD who underwent invasive coronary angiography (ICA) were retrospectively matched (for age, body mass index and cardiovascular risk factors) with 302 patients without functional lung diseases. Quality and onset of symptoms prior to ICA were documented, and individual patients' pretest probabilities according to European Society of Cardiology (ESC) guidelines were calculated. Endpoints were delay of ICA referral after symptom onset and clinical outcome, defined as subsequent revascularisation.
Results:
Mean delay between symptom onset and ICA was 19.9±22.0 months in COPD patients compared to 8.3±12.7 months in the control group (p<0.0001). COPD patients had a lower rate of typical chest pain (25.2% versus 38.1%, p=0.0009), and dyspnoea only (18.2% versus 26.8%, p=0.015). Sub-analysis of Global Initiative for Chronic Obstructive Lung Disease (GOLD) grades revealed an incremental delay with increasing COPD severity: GOLD 1: 16.1±17.3 months; GOLD 2: 17.6±22.1 months; GOLD 3: 20.1±21.3 months; and GOLD 4: 24.2±23.4 months. Overall significant CAD prevalence (>70% stenosis) was 35.3%; the revascularisation rate increased with higher pretest probability for the control group but decreased for patients with COPD GOLD 1-4.
Conclusion:
Patients with COPD are insufficiently evaluated for CAD due to overlapping symptoms. Current CAD risk scores for stable chest pain appear inappropriate for patients with COPD.
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