Underdiagnosis and prognosis of chronic obstructive pulmonary disease after percutaneous coronary intervention: a prospective study

Abstract

Background

Retrospective studies based on clinical data and without spirometric confirmation suggest a poorer prognosis of patients with ischemic heart disease (IHD) and chronic obstructive pulmonary disease (COPD) following percutaneous coronary intervention (PCI). The impact of undiagnosed COPD in these patients is unknown. We aimed to evaluate the prognostic impact of COPD – previously or newly diagnosed – in patients with IHD treated with PCI.

Methods

Patients with IHD confirmed by PCI were consecutively included. After PCI they underwent forced spirometry and evaluation for cardiovascular risk factors. All-cause mortality, new cardiovascular events, and their combined endpoint were analyzed.

Results

A total of 133 patients (78%) male, with a mean (SD) age of 63 (10.12) years were included. Of these, 33 (24.8%) met the spirometric criteria for COPD, of whom 81.8% were undiagnosed. IHD patients with COPD were older, had more coronary vessels affected, and a greater history of previous myocardial infarction. Median follow-up was 934 days (interquartile range [25%–75%]: 546–1,160). COPD patients had greater mortality ( P=0.008; hazard ratio [HR]: 8.85; 95% confidence interval [CI]: 1.76–44.47) and number of cardiovascular events ( P=0.024; HR: 1.87; 95% CI: 1.04–3.33), even those without a previous diagnosis of COPD ( P=0.01; HR: 1.78; 95% CI: 1.12–2.83). These differences remained after adjustment for sex, age, number of coronary vessels affected, and previous myocardial infarction ( P=0.025; HR: 1.83; 95% CI: 1.08–3.1).

Conclusion

Prevalence and underdiagnosis of COPD in patients with IHD who undergo PCI are both high. These patients have an independent greater mortality and a higher number of cardiovascular events during follow-up.

Journal

Journal ID (nlm-ta): Int J Chron Obstruct Pulmon Dis

Journal ID (iso-abbrev): Int J Chron Obstruct Pulmon Dis

Journal ID (publisher-id): International Journal of COPD

Title: International Journal of Chronic Obstructive Pulmonary Disease

Publisher: Dove Medical Press

ISSN (Print): 1176-9106

ISSN (Electronic): 1178-2005

Publication date Collection: 2015

Publication date (Electronic): 16 July 2015

Volume: 10

Pages: 1353-1361

Affiliations

[1 ]Department of Internal Medicine, Mutua de Terrassa University Hospital, Terrassa, Spain

[2 ]Pneumology Service, Mutua de Terrassa University Hospital, Terrassa, Spain

[3 ]Medical Department, Menarini Pharmaceutical, Barcelona, Spain

[4 ]Cardiology Service, Mutua de Terrassa University Hospital, Terrassa, Spain

[5 ]Instituto de Investigación Sanitaria Princesa (IP), Universidad Autónoma de Madrid, Madrid, Spain

Author notes

Correspondence: Pere Almagro, Department of Internal Medicine, Mutua de Terrassa University Hospital, Plaza Dr Robert n ^⍛ 5, Terrassa 08226, Barcelona, Spain, Email 19908pam@ 123456comb.cat

Article

Publisher ID: copd-10-1353

DOI: 10.2147/COPD.S84482

PMC ID: 4509531

Copyright statement: © 2015 Almagro et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License

License:

The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

Categories

Subject: Original Research