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ECG-based risk factors for adverse cardiopulmonary events and treatment outcomes in COPD
R Chad Wade1, Fernando J Martinez2, Gerard J Criner3
1Division of Pulmonary, Allergy, and Critical Care Medicine, Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA.
Insights
Two ECG markers, Cardiac Infarction Injury Score (CIIS) and P pulmonale, predict adverse cardiopulmonary events in COPD patients. Higher scores indicate increased risk for death, hospitalisation, and exacerbations, suggesting their clinical relevance.
Area of Science:
- Cardiology
- Pulmonology
- Medical Diagnostics
Background:
- Chronic Obstructive Pulmonary Disease (COPD) is associated with high mortality, often exacerbated by comorbid cardiovascular disease.
- Electrocardiogram (ECG) markers like Cardiac Infarction Injury Score (CIIS) and P pulmonale are explored for prognostic value in COPD.
Purpose of the Study:
- To investigate the prognostic utility of CIIS and P pulmonale for adverse cardiopulmonary events in COPD patients.
- To assess the impact of these ECG markers on outcomes such as mortality, hospitalisation, and COPD exacerbations.
Main Methods:
- A post hoc analysis of the IMPACT trial data involving 9448 patients.
- Outcomes were stratified by CIIS thresholds (≥20 vs. <20) and presence of P pulmonale.
- Adverse events included all-cause death, hospitalisation or death, cardiovascular events, and COPD exacerbations.
Main Results:
- Patients with CIIS ≥20 showed significantly higher odds of all-cause death, hospitalisation or death, cardiovascular events, and COPD exacerbations.
- P pulmonale was also associated with increased odds of all-cause death, hospitalisation or death, and COPD exacerbations.
- A combined model indicated that CIIS ≥20 and P pulmonale together significantly increased the risk of all-cause death and severe COPD exacerbations.
Conclusions:
- CIIS and P pulmonale demonstrate potential as valuable clinical risk indicators for adverse cardiopulmonary events in COPD.
- These ECG markers may aid in identifying high-risk COPD patients who could benefit from targeted interventions.
Background:
COPD has high mortality, compounded by comorbid cardiovascular disease. We investigated two ECG markers, Cardiac Infarction Injury Score (CIIS) and P pulmonale, as prognostic tools for adverse cardiopulmonary events in COPD.
Methods:
This was a p ost hoc analysis of the IMPACT trial. Outcomes included odds (odds ratio, 95% confidence intervals) of adverse cardiopulmonary events stratified by CIIS threshold (<20 versus ≥20) and P pulmonale (baseline). Events included all-cause death, hospitalisation or death, cardiovascular adverse event of special interest, severe COPD exacerbations, and moderate/severe COPD exacerbations. We also assessed the effects of fluticasone furoate/umeclidinium/vilanterol versus fluticasone furoate/vilanterol or umeclidinium/vilanterol based on CIIS and P pulmonale.
Results:
We included 9448 patients. Patients with CIIS ≥20 (versus CIIS <20) had greater odds of all-cause death (OR 1.73, 95% CI 1.27-2.37, p<0.001), hospitalisation or death (OR 1.33, 95% CI 1.17-1.50, p<0.001), cardiovascular adverse event of special interest (OR 1.27, 95% CI 1.08-1.48, p<0.005), severe COPD exacerbations (OR 1.41, 95% CI 1.21-1.64, p<0.001) and moderate/severe COPD exacerbations (OR 1.25, 95% CI 1.13-1.40, p<0.001). Patients with P pulmonale (versus without) had greater odds of all-cause death (OR 2.25, 95% CI 1.54-3.29, p<0.001), hospitalisation or death (OR 1.51, 95% CI 1.28-1.79, p<0.001), severe COPD exacerbations (OR 2.00, 95% CI 1.65-2.41, p<0.001) and moderate/severe COPD exacerbations (OR 1.25, 95% CI 1.08-1.46, p<0.001). A combined model demonstrated that patients with CIIS ≥20 and P pulmonale had increased risk of all-cause death (OR 3.38, 95% CI 1.23-9.30, p=0.019), hospitalisation or death (OR 1.61, 95% CI 1.14-2.22, p=0.004) and rate of severe COPD exacerbations (OR 1.89, 95% CI 1.22-2.91, p=0.004) and moderate/severe COPD exacerbations (OR 1.25, 95% CI 1.00-1.56, p=0.046). The risk of all-cause death and cardiovascular adverse events of special interest was reduced with fluticasone furoate/umeclidinium/vilanterol versus umeclidinium/vilanterol in patients with CIIS ≥20, but not CIIS <20.
Conclusions:
These findings suggest the potential clinical relevance of CIIS and P pulmonale as risk indicators for adverse cardiopulmonary events in COPD.
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