Invasive coronary angiography in patients with acute exacerbated COPD and elevated plasma troponin

Pizarro, Carmen; Herweg-Steffens, Neele; Buchenroth, Martin; Schulte, Wolfgang; Schaefer, Christian; Hammerstingl, Christoph; Werner, Nikos; Nickenig, Georg; Skowasch, Dirk

doi:10.2147/copd.s110746

Cited by 23 publications

(19 citation statements)

References 27 publications

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“…45,46 In a cohort study performed in patients with severe exacerbations of COPD and elevated levels of troponins at admission, coronary angiography performed 72 hours after hospitalization showed significant coronary stenosis (>50%) in major coronary arteries in 67% of patients, of which 39% required percutaneous coronary intervention. 47…”

Section: Serum Biomarkersmentioning

confidence: 99%

<p>Insights into Chronic Obstructive Pulmonary Disease as Critical Risk Factor for Cardiovascular Disease</p>

Almagro¹,

Boixeda²,

Díez-Manglano³

et al. 2020

COPD

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In patients with chronic obstructive pulmonary disease (COPD), cardiovascular comorbidities are highly prevalent and associated with considerable morbidity and mortality. This coincidence is increasingly seen in the context of a "cardiopulmonary continuum" rather than being simply attributed to shared risk factors, in particular, cigarette smoking. Both disease entities are centrally linked to systemic inflammation as well as aging, arterial stiffness, and several common biomarkers that led to the development of pulmonary hypertension, left ventricular diastolic dysfunction, atherosclerosis, and reduced physical activity and exercise capacity. For these reasons, COPD should be considered an independent factor of high cardiovascular risk, and efforts should be directed to early identification of cardiovascular disease (CVD) in COPD patients. Assessment of the overall cardiovascular risk is especially important in patients with severe exacerbation episodes, and the same therapeutic target levels for glycosylated hemoglobin, low-density lipoprotein cholesterol (LDL-C), or blood pressure than those recommended by clinical practice guidelines for patients at high cardiovascular risk, should be achieved. In this review, we will discuss the most recent evidence of the role of COPD as a critical cardiovascular risk factor and try to find new insights and potential prevention strategies for this disease.

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Section: Serum Biomarkersmentioning

confidence: 99%

<p>Insights into Chronic Obstructive Pulmonary Disease as Critical Risk Factor for Cardiovascular Disease</p>

Almagro¹,

Boixeda²,

Díez-Manglano³

et al. 2020

COPD

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“… 14 , 30 Moreover, patients admitted for COPD exacerbation were found to have a high troponin level in the absence of acute coronary symptoms and a subsequent coronary angiography showed significant coronary stenosis. 31 A recent extended follow-up study on patients with CAD showed persistent increase of cardiovascular mortality in patients with coexisting COPD. 32 Additionally, when treating patients who are diagnosed with both COPD and CAD, the long-term use of beta-2 agonists is considered a safe practice, 33 and the use of cardio-selective beta-blockers in CAD may even lower the mortality of patients with COPD.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of undiagnosed COPD in male patients with coronary artery disease: a cross-sectional study in Jordan

Khassawneh¹,

Samrah²,

Jarrah³

et al. 2018

COPD

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PurposeCOPD and coronary artery disease (CAD) are common chronic diseases with shared risk factors. COPD continues to be largely underdiagnosed and undertreated. We aimed to describe the prevalence and predictors of undiagnosed COPD in Jordanian men with CAD.Patients and methodsIn a cross-sectional study conducted at a referral center in Jordan, male patients who underwent coronary angiography for suspected CAD and reported $10 pack-year of cigarette smoking were recruited. Pre- and post-bronchodilator spirometry was undertaken for all participants, and COPD was defined as post-bronchodilator FEV1/FVC <70%. The finding of ≥50% coronary luminal narrowing confirmed the presence of CAD.ResultsSpirometry was undertaken for 376 men with mean age of 56.02±10.55 years, and 72.6% were active cigarettes smokers with a mean pack-year of 55.89±34.25. A CAD diagnosis was confirmed in 300 (79.8%) men. Spirometric criteria for COPD were met in 76 (15.7%) patients, of whom 91.5% were not previously diagnosed. COPD-related symptoms were common: chronic cough (44.4%), dyspnea (66.2%), and wheezes (27.9%). COPD was more common in patients with (18.0%) compared to patients without (6.6%) CAD (P=0.014). Multivariate logistic regression showed that the risk of COPD was higher in patients with CAD (OR 3.16, 95% CI, 1.10–9.09, P=0.033) and in those with chronic bronchitis (OR 13.07, 95% CI, 6.69–25.52, P<0.001).ConclusionThere was a high prevalence of COPD among male patients with CAD and most were underdiagnosed despite having respiratory symptoms. Male smokers with CAD and respiratory symptoms should be evaluated for airflow limitation and the presence of COPD.

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“…Also, cardiovascular disease is a frequent comorbidity and a significant cause of morbidity and mortality in COPD patients ( 40 - 44 ). In patients with AECOPD and an elevated troponin I level, coronary angiography confirmed ischemic heart disease in 67%, and 38.6% required a coronary revascularization ( 42 ). In our patients, additional diagnostic evaluation (echocardiography, coronary angiography, and CT pulmonary angiography) was performed to exclude acute coronary incident or pulmonary embolism.…”

Section: Discussionmentioning

confidence: 99%

Anemia, hypoalbuminemia, and elevated troponin levels as risk factors for respiratory failure in patients with severe exacerbations of chronic obstructive pulmonary disease requiring invasive mechanical ventilation

et al. 2017

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AimTo determine in-hospital and post-discharge mortality, readmission rates, and predictors of invasive mechanical ventilation (IMV) in patients treated at intensive care unit (ICU) due to acute exacerbations of chronic obstructive pulmonary disease (AECOPD).MethodsA retrospective observational cohort study included all patients treated at a respiratory ICU for AECOPD during one year. A total of 62 patients (41 men) with mean age 68.4 ± 10.4 years were analyzed for outcomes including in-hospital and post-discharge mortality, readmission rates, and IMV. Patients’ demographic, hematologic, biochemical data and arterial blood gas (ABG) values were recorded on admission to hospital. Mean duration of follow-up time was 2.4 years.ResultsOf 62 patients, 7 (11.3%) died during incident hospitalization and 21 (33.9%) died during the follow-up. The overall 2.4-year mortality was 45.2%. Twenty nine (46.8%) patients were readmitted due to AECOPD. The average number of readmissions was 1.2. Multivariate analysis showed that blood pH, bicarbonate levels, low albumin, low serum chloride, and low hemoglobin were significant predictors of IMV during incident hospitalization (P < 0.001 for the overall model fit).ConclusionHigh in-hospital and post-discharge mortality and high readmission rates in our patients treated due to AECOPD at ICU indicate that these patients represent a high risk group in need of close monitoring. Our results suggested that anemia, hypoalbuminemia, and elevated troponin levels were risk factors for the need of IMV in severe AECOPD. Identification of such high-risk patients could provide the opportunity for administration of an appropriate and timely treatment.

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Invasive coronary angiography in patients with acute exacerbated COPD and elevated plasma troponin

Cited by 23 publications

References 27 publications

<p>Insights into Chronic Obstructive Pulmonary Disease as Critical Risk Factor for Cardiovascular Disease</p>

<p>Insights into Chronic Obstructive Pulmonary Disease as Critical Risk Factor for Cardiovascular Disease</p>

Prevalence of undiagnosed COPD in male patients with coronary artery disease: a cross-sectional study in Jordan

Anemia, hypoalbuminemia, and elevated troponin levels as risk factors for respiratory failure in patients with severe exacerbations of chronic obstructive pulmonary disease requiring invasive mechanical ventilation

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