Chronic obstructive pulmonary disease affects the angiographic presentation and outcomes of patients with coronary artery disease treated with percutaneous coronary interventions

Abstract

INTRODUCTION The incidence of chronic obstructive pulmonary disease (COPD) in patients treated with percutaneous coronary intervention (PCI) is underestimated, and the effect of COPD on atherosclerosis and the outcomes of PCI is not fully understood. OBJECTIVES The aim of this study was to assess the impact of COPD on periprocedural outcomes of PCI, as well as its relationship with clinical presentation and the type of coronary artery lesions. PATIENTS AND METHODS Data were prospectively collected using a national electronic registry of PCI procedures performed in Poland between January 2015 and December 2016. Out of the 221 187 PCIs, 5594 patients had been diagnosed with COPD before the intervention. RESULTS Patients with COPD were older than those without COPD (mean [SD] age, 70.3 [9.9] years vs 67 [10.8] years; P <0.001) and more often were males (72.3% vs 67.8%; P <0.001). Non-ST‑segment elevation myocardial infarction (NSTEMI) was a more common clinical presentation of coronary artery disease (CAD) in the COPD group, while ST‑segment elevation myocardial infarction (STEMI) occurred more frequently in the non‑COPD group. Multivessel disease (MVD) with or without left main coronary artery (LMCA) involvement and separate LMCA was diagnosed more often in the COPD group. At baseline, the culprit lesion was more often restenosis and in‑stent thrombosis in the COPD group, whereas de‑novo lesion-in the non‑COPD group. The rates of periprocedural mortality and myocardial infarction did not differ between the groups with and without COPD (0.13% vs 0.12%, P = 0.88 and 0.53% vs 0.45%, P = 0.39, respectively). COPD was found to be an independent predictor of restenosis assessed before PCI in patients with a history of PCI (P = 0.006). CONCLUSIONS Patients with COPD diagnosed before PCI are at an increased risk of MVD with or without LMCA involvement and NSTEMI. Restenosis and in‑stent thrombosis occur more often in patients with COPD before PCI.

The association between recent hospitalized COPD exacerbations and adverse outcomes after percutaneous coronary intervention: a nationwide cohort study

“…Probably because of the major concern regarding the use of spirometry in patients presenting with heart attack,8,34 spirometry was systemically applied to determine all participants with COPD in only one among related PCI studies 24. Our approach was used in previous studies,13,18,19,22,23,25 and has been considered robust enough to identify patients with real-world COPD 15. In addition, a fraction of data missing or miscoding is inherent in studies using a large database, eg, COPD exacerbation accompanied by cardiac events or cardiac events per se being potentially misclassified as COPD exacerbation because of their similar clinical presentation, but such errors are likely random from a nationwide database and should not be a valid argument for our findings as nondifferential misclassification may lead to a bias toward the null.…”

“…However, outcomes of patients experiencing recent hospitalized exacerbations before PCI have not been elucidated. Also, some studies demonstrated that COPD patients were at increased risk for hospital mortality,13,18,20 while others did not find an adverse effect of COPD 12,14–17,19. In the era of widespread use of PCI, the prognostic significance of COPD and recent hospitalized exacerbations need further clarification.…”

Current trends and procedural outcomes in the era of rotational atherectomy expansion in Poland in the period 2014–2017 (based on the nationwide ORPKI registry)

“…Prospectively collected data on PCI practice in Poland were obtained from the ORPKI Polish National dataset, which is coordinated nationwide by Jagiellonian University Medical College in cooperation with AISN PTK (Association of Cardiovascular Interventions, Polish Cardiac Society). Database characteristics and data collection methods have been previously published [3, 5–7]. Patients were categorized according to whether they were treated with RA or not over a 4-year period (2014–2017).…”

Chronic obstructive pulmonary disease and periprocedural complications in patients undergoing percutaneous coronary interventions

“…Our study confirmed that STEMI patients had a high rate of no-reflows (2.8%), CAs (2.6%), and the overall periprocedural complication rate was also high (6.2%) compared to other clinical presentations of CAD. Moreover, the relationship between no-reflows and the COPD as a prothrombotic state have been more widely discussed in two previously published manuscripts [ 17 , 18 ]. Furthermore, according to our knowledge, this is the first study verifying that among several confirmed predictors, smoking and COPD are independent risk factors of a higher incidence of no-reflows in patients undergoing PCI.…”