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



Wei-Chieh Lin, Chang-Wen Chen, Chin-Li Lu, et al.

Intl J Chron Obstruct Pulmon Dis 2019;14:169–79.

doi.org/10.2147/COPD.S187345

 

Cardiovascular disease is one of the leading causes of death in mild-to-moderate COPD, and accounts for approximately one-third of mortalities in overall COPD patients.

There are many findings highlighting the detrimental impact of COPD exacerbations on patients with concomitant CAD, including those suggesting a link between COPD and the development of subclinical coronary atherosclerosis, CAD and myocardial infarction, and findings suggesting that the risk of myocardial ischaemia may be increased following an exacerbation of COPD.

Given the high prevalence of COPD and its potential risks in CAD patients, there has been considerable interest in exploring whether COPD might worsen the prognosis of PCI, given that it is the most commonly used revascularisation procedure. However, outcomes of patients experiencing recent hospitalised exacerbations before PCI have not been studied.

The National Health Insurance Research Database of Taiwan was used in a retrospective cohort study to test the hypotheses that COPD and recent hospitalised exacerbations might be associated with increased risks of hospital mortality and adverse outcomes during the follow-up period after PCI.

The study cohort was comprised of 215,275 adult patients who underwent first-time PCI between 1 January 2000 and 31 December 2012. Of these, 15,485 had COPD. And of these, 2489 had been hospitalised for an exacerbation within one year prior to PCI. The risks of hospital mortality, overall mortality and adverse cardiovascular outcomes after PCI in relation to COPD, and the frequency and timing of recent hospitalised exacerbations within one year before PCI, were estimated.

The study authors found COPD to be associated with increased risks of hospital mortality, overall mortality, ischaemic events, cerebrovascular events and MACCE during follow-up after PCI. Regarding cerebrovascular events, ischaemic rather that haemorrhagic stroke was the more likely. In COPD patients, recent hospitalised exacerbations further increased the risks of overall mortality, ischaemic events and MACCE following PCI. Patients with more frequent or more recent hospitalised exacerbations had a trend towards higher risks of these adverse events, especially those with two or more exacerbations within one year or an exacerbation within one month before PCI.

The conclusion is a call for integrated care to alleviate COPD-related morbidity and mortality after PCI, especially for those with a recent hospitalised exacerbation.




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