Interactions Between COPD and Outcomes After Percutaneous Coronary Intervention Tomas Konecny, Krishen Somers, Marek Orban, Yuki Koshino, Ryan J. Lennon, Paul D. Scanlon and Charanjit S. Rihal Chest 2010;138; ; Prepublished online April 9, 2010; DOI /chest R1 정현준

Introduction  Coronary artery disease  a leading cause of mortality among American men and women  COPD  the fourth leading cause of mortality and is highly prevalent among patients with CAD  in the general population and in patients with CAD undergoing coronary bypass grafting : overall mortality and cardiovascular mortality ↑  On patient with PCI : limited study  Recent evidence “ Potential pathophysiologic links between CAD and COPD”  are independent of smoking  chronic elevation of inflammatory markers, pulmonary hypertension, impaired neurohumoral activation, abnormal arterial stiffness, Sleep apnea with nocturnal desaturations.

 retrospective cross-sectional analysis  Prospectively acquired data from the Mayo Clinic Rochester Coronary Catheterization Laboratory Registry (Rochester, MN)  was surveyed by telephone contact  at 6 months, 1 year, and then annually after the procedure  Population  who underwent coronary intervention between January 1995 and August 2008 (Cutoff point : 1995 yr)  Primary outcomes : all-cause mortality, cardiac mortality, MI after discharge from index PCI  Definition of MI : prolonged angina lasting 20 minute, a rise in the serum biomarker, ST-segment/T-wave changes or new Q- waves on ECG materials and methods cross-sectional study and control population

 COPD  Diagnosis by International Classification of Diseases, 9th edition (ICD-9)  Severity : used results of PFTs  Very severe : FEV1/FVC ≤ 70%, FEV1 ≤30%  Severe : FEV1/FVC ≤ 70%, 30%≤ FEV1 ≤50%  Mild to moderate : FEV1/FVC ≤ 70%, FEV1 ＞ 50%  FEV1/FVC ＞ 70%  Statistical analysis  Continuous data : mean +- SD  Discrete data : frequency(group percentage)  x ² test, two-sample t test, generalized linear model  Cox proportional hazard models materials and methods COPD, statistical analysis

results baseline patient characteristics, Table 1 Total of 14,346

 median lengths of follow-up for the COPD and no COPD groups  all-cause mortality : 4.1 ( ) yrs vs 4.1 ( ) yrs  cardiac mortality : 4.0 ( ) yrs vs 4.1 ( ) yrs  occurrence of MI : 3.4 ( ) yrs vs 3.8 ( )yrs  Gathered outcome data  90.4% of all patients from within 2years prior to data collection  67% of all patients from within 1year of data collection Results lengths of follow-up

Results primary outcome, univariate analysis, Fig.1

Results primary outcome, multivariate analysis, Fig.2 Male gender age hypertension Diabetes Meliitus Hx of malignancy Current smoking LVEF ≤ 40% Elective PCI DES use COPD hypercholesterolemia OR 1.79 OR 1.57 OR 1.30

Results COPD severity and outcomes, Fig.3 * 1,192 (60%) patients c COPD very severe : 98 (8%) severe : 269 (23%) moderate : 447 (38%) mild : 38 (3%) FEV1/FVC ＞ 70% : 340 (29%)

Results COPD severity and outcomes, Fig.4

 smoking status during the first follow-up at 6 months after the PCI  during the index PCI : 2,560 (19%)  At the 6-month follow up : 1,057 (8%)  multivariate analysis  COPD remained a significant risk factor (95% CI) for  all-cause mortality : OR, 1.87, ; P ＜  cardiac mortality : OR, 1.80; ; P ＜  Occurrence of MI : OR, 1.33; ; P ＜ Reserts active smoking during follow up

conclusion  patients with COPD have a higher mortality after PCI  Increased risk for adverse cardiovascular outcomes  Increasing severity of COPD  decreased survival after PCI  Contribute to determine intensity of f/u and assign targeted therapeutic intervention  Data on patients with COPD undergoing PCI are limited.  Two studies : Definition & severity of COPD, cardiovascular outcomes  Association between COPD and CAD  chronic elevation of inflammatory markers  pulmonary hypertension, RHF  impaired neurohumoral activation  abnormal arterial stiffness  Sleep apnea with nocturnal desaturations.

conclusion  Baseline characteristics : with COPD vs without COPD  Older, increased prevalence of cardiovascular risk factors  more prevalant in the personal history of cardiovascular disease  COPD in the multivariate analysis : additional,,strong risk factor  Consistent with reports from the general population  PCI procedures on patients with COPD  Similar success and complication rates, number of stents placed  the use of drug-eluting stents ↓, nonelective PCI ↑  Included only patients undergoing elective PCI  Active smoking and smoking history  a significant difference in the number of current smokers between the COPD and non-COPD group (30% vs 17%)  Current - smokers

Conclusion study limitations  Nonrandomized, retrospective, cross sectional analysis  The use of ICD-9 coding is imperfect in defining all patients with COPD.  some of the patients in the non-COPD cohort : as PFT was not performed in them.  PFT results were available in 60% of the patients with COPD.