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

Abstract

PurposeCOPD is associated with coronary artery disease, and exacerbations are major events in COPD. However, the impact of recent hospitalized exacerbations on outcomes of percutaneous coronary intervention (PCI) remains underdetermined.Patients and methodsUsing the National Health Insurance Research Database of Taiwan, we identified 215,275 adult patients who underwent first-time PCI between 2000 and 2012. Among these patients, 15,485 patients had COPD. The risks of hospital mortality, overall mortality, and adverse cardiovascular outcomes after PCI (ie, ischemic events, repeat revascularization, cerebrovascular events, and major adverse cardiac and cerebrovascular events [MACCEs]) in relation to COPD, and the frequency and timing of recent hospitalized exacerbations within 1 year before PCI were estimated.ResultsCOPD was independently associated with increased risks of hospital mortality, overall mortality, ischemic events, cerebrovascular events, and MACCE during follow-up after PCI. Among cerebrovascular events, ischemic rather than hemorrhagic stroke was more likely to occur. In COPD patients, recent hospitalized exacerbations further increased the risks of overall mortality, ischemic events, and MACCE following PCI. Notably, patients with more frequent or more recent hospitalized exacerbations had a trend toward higher risks of these adverse events (all P-values for trend <0.0001), especially those with ≥2 exacerbations within 1 year or any exacerbation within 1 month before PCI.ConclusionIntegrated care is urgently needed to alleviate COPD-related morbidity and mortality after PCI, especially for patients with a recent hospitalized exacerbation.

Assessment of medical management in Coronary Type 2 Diabetic patients with previous percutaneous coronary intervention in Spain: A retrospective analysis of electronic health records using Natural Language Processing

“…In our study, we found that the risk of MACE in T2D-THEMIS-like patients according to the multivariate model was associated with the extent and severity of atherothrombosis (MVD) and with other risk factors such as history of heart valve disease and respiratory disorders (COPD/asthma). These risk factors have previously been shown to affect outcomes in general population and diabetic patients at high risk for ischemic events, specifically in patients with T2D and CAD with no history of MI or stroke and previous PCI revascularization [40][41][42][43]. Finally, the multivariate approach also revealed that such treatments as clopidogrel and statins were associated to a lower risk for MACE after adjusting for other factors in this clinical population; further research is warranted to confirm these findings in future studies.…”

Mortality of Cardiovascular Events in Patients With COPD and Preceding Hospitalization for Acute Exacerbation

“…7,28 COPD is associated with cardiovascular mortality following coronary revascularization with PCI, 29 and hospitalization for AE plays a role. 30 In addition to the observational study in England and Wales 17 and post hoc cohort analysis of the SUMMIT trial, 18 several other time-based reports have shown the association between recent AE and cardiovascular events during the period following an AE. 13,14,[16][17][18]26,28 In a secondary analysis of the Understanding Potential Long-Term Impacts on Function With Tiotropium (UPLIFT) trial, AE was associated with an increased risk of severe adverse cardiovascular events within both the first 30 and 180 days following an AE episode, with the highest risk occurring in the first 30 days.…”

Postoperative Delirium in Patients with Chronic Obstructive Pulmonary Disease after Coronary Artery Bypass Grafting

“…Studies have shown that COPD alone is an independent predictor of hospital mortality in patients after CABG [24][25][26][27][28][29]. Huang et al showed that this group of patients had an increased perioperative risk and mortality, regardless of the performed coronary intervention of percutaneous coronary intervention (PCI) or CABG [24].…”