Association between chronic obstructive pulmonary disease and in-hospital mortality after percutaneous coronary
Nadine Hochhausen1, Mare Mechelinck2, Sebastian Billig2
1Department of Anaesthesiology, Medical Faculty, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany. nhochhausen@ukaachen.de.
Insights
Chronic obstructive pulmonary disease (COPD) patients undergoing percutaneous coronary intervention (PCI) had longer hospital stays and ventilation times. Mild to severe COPD showed lower mortality, but very severe COPD, exacerbations, and infections increased mortality risk.
Area of Science:
- Cardiology
- Pulmonology
- Public Health
Background:
- Chronic obstructive pulmonary disease (COPD) is a major global health concern.
- The impact of COPD on outcomes following percutaneous coronary intervention (PCI) requires further clarification.
- Understanding these outcomes is crucial for managing patients with both conditions.
Purpose of the Study:
- To investigate the association between COPD and outcomes after PCI.
- To compare in-hospital mortality, length of stay, and ventilation time in patients with and without COPD.
- To analyze the influence of COPD severity, exacerbation, and infection on PCI outcomes.
Main Methods:
- Retrospective cohort study analyzing hospitalized patients undergoing PCI in Germany (2015-2019).
- Comparison of outcomes between patients with and without COPD, stratified by COPD severity, exacerbation (COPDe), and infection (COPDi).
- Statistical analysis of in-hospital mortality, hospital length of stay, and peri-interventional ventilation time (VT).
Main Results:
- Over 3.4 million PCI cases were analyzed; 8.4% had COPD.
- COPD patients experienced higher mortality (2.4% vs. 2.0%), longer hospital stays (5 vs. 3 days), and increased ventilation time (26 vs. 23 hours).
- Paradoxically, mild to severe COPD was linked to lower mortality and reduced VT, while very severe COPD, COPDe, and COPDi showed increased mortality risk.
Conclusions:
- COPD significantly impacts outcomes after PCI, with varying effects based on severity and complications.
- Mild to moderate COPD may be associated with better outcomes, contrary to expectations.
- Further research is needed to explore the role of comorbidities in these observed associations.
Abstract:
Chronic obstructive pulmonary disease (COPD) is one of the leading chronic diseases worldwide. However, the impact of COPD on outcome after percutaneous coronary intervention (PCI) remains unclear. In this retrospective cohort study, we analyzed the data of hospitalized patients undergoing PCI in Germany between 2015 and 2019. We compared in-hospital mortality, hospital length of stay and peri-interventional ventilation time (VT) in patients with and without COPD, including different COPD severity grades, COPD with exacerbation (COPDe) and infection (COPDi). We analyzed the data of 3,464,369 cases undergoing PCI. A total of 291,707 patients (8.4%) suffered from COPD. Patients suffering from COPD died more often (2.4% vs. 2.0%; p < 0.001), stayed longer hospitalized (5 days (2-10) vs. 3 days (1-6); p < 0.001), were more frequent (7.2% vs. 3.2%) and longer ventilated (26 h (7-88) vs. 23 h (5-92); p < 0.001). Surprisingly, COPD was associated with a 0.78-fold odds of in-hospital mortality and with reduced VT (- 1.94 h, 95% CI, - 4.34 to 0.43). Mild to severe COPD was associated with a lower risk of in-hospital mortality and reduced VT, whereas very severe COPD, COPDe and COPDi showed a higher risk of in-hospital mortality. We found a paradoxical association between mild to severe COPD and in-hospital mortality, whereas very severe COPD, COPDe and COPDi were associated with higher in-hospital mortality. Further investigations should illuminate, whether comorbidities affect these associations.
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