Major adverse cardiac events and mortality in chronic obstructive pulmonary disease following percutaneous coronary intervention: a systematic review and meta-analysis

Bundhun, Pravesh Kumar; Gupta, Chakshu; Xu, Guang Ma

doi:10.1186/s12872-017-0622-2

Cited by 17 publications

(14 citation statements)

References 19 publications

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“…In a systematic review and meta-analysis of 10 studies (7518 patients with COPD and 65,451 patients without COPD), a comparison of major adverse cardiac events (MACEs) and mortality following percutaneous coronary intervention revealed that in-hospital (OR 1.40, 95% CI 1.19-1.65; P = 0.001) and long-term MACEs (OR 1.58, 95% CI 1.38-1.81, P = 0.001) were significantly higher in patients with COPD. 62 Therefore, COPD should be considered a risk factor for the development of adverse clinical outcomes following coronary revascularization procedures. Regrettably, in all of these studies, definition of COPD is based in the clinical history or discharge codes, without spirometric confirmation and underdiagnosis of COPD in IHD is about 80%.…”

Section: Systematic Reviews and Meta-analysismentioning

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: Systematic Reviews and Meta-analysismentioning

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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“…COPD is a common comorbidity in patients with chronic cardiac diseases and contributes to poor outcomes including increased mortality following cardiac procedures 6‐11 . Its role in mitral valve periprocedural complications has been seldom studied.…”

Section: Discussionmentioning

confidence: 99%

“…COPD is a common comorbidity in patients with chronic cardiac diseases and contributes to poor outcomes including increased mortality following cardiac procedures. [6][7][8][9][10][11] Its role in mitral valve periprocedural complications has been seldom studied. One small, prospective observational study showed COPD to be an independent predictor of composite mortality, cardiac re-hospitalization, re-intervention, and major cerebro-vascular and cardiac events.…”

Section: Methodsmentioning

confidence: 99%

In‐hospital outcomes of percutaneous mitral valve repair in patients with chronic obstructive pulmonary disease: insights from the national inpatient sample database

Khan

Farjo

Khan

et al. 2020

Cathet Cardio Intervent

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Objectives: We aimed to assess the in-hospital outcomes in patients with mitral regurgitation treated with percutaneous mitral valve repair (PMVR) among patients with chronic obstructive pulmonary disease (COPD). Background: There is lack of data on the outcomes of PMVR for mitral regurgitation in patients with COPD. Methods: We analyzed the national inpatient sample (NIS) database from January 2012 to December 2016. Results: A total of 9125 patients underwent PMVR in the period between January 2012 and December 2016, of whom 2,495 (27.3%) patients had concomitant COPD. Comparing COPD patients to non-COPD patients, COPD patients had higher proportion of females (48.3% vs. 46.6%, p = .16), were younger (75.8 ± 10.0 years vs. 76.4 ± 12.2 years; p = .04), had higher prevalence of peripheral vascular disease (17.4% vs. 13.5%; p < .01) and renal failure (39.3% vs. 37%; p < .01). After propensity matching, there was no significant difference in mortality among the COPD group versus non-COPD patients (2.6% vs. 2.9%; p = .6). Patients with COPD had higher proportion of in-hospital morbidities including St-segment elevation myocardial infarction (1.8% vs. 1.0%; p = .02), cardiogenic shock (1.4% vs. 0.4%; p < .01), vascular complications (2% vs. 0.8; p < .01), pneumothorax (1% vs. 0.4%; p < .01), and septic shock (1.2% vs. 0.4%; p < .01). Moreover, surrogates of severe disability (mechanical intubation and non-home discharges), cost of hospitalization, and length of stay were higher in the COPD group. Conclusions: There was no difference in mortality between the COPD and non-COPD patients after PMVR. Moreover, we observed higher rates of in-hospital morbidities, surrogates of severe disability, and higher resources utilization by the COPD group.

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“…9,10 Patient was considered adherent in case there was no evidence of randomized treatment discontinuation prior to follow-up visits scheduled at 30 days, 3, 6, 12, 18, and 24 months after the index procedure 9,10 (Supplementary material online, Appendix per-protocol restart of DAPT allowed: (i) ticagrelor and aspirin for 30 days in the experimental treatment strategy group, (ii) DAPT with ticagrelor and aspirin (ACS, stable CAD patients already on ticagrelor or prasugrel), clopidogrel and aspirin (stable CAD) for 365 days in the standard treatment strategy group. 1…”

Section: Patient Populationmentioning

confidence: 99%

“…Patients with coronary artery disease (CAD) and chronic obstructive pulmonary disease (COPD) represent a population at increased risk for adverse clinical events, periprocedural complications, comorbidities, and polypharmacy. [1][2][3] In PLATO, dual antiplatelet therapy (DAPT) consisting of ticagrelor and aspirin reduced the composite primary endpoint of cardiovascular death, myocardial infarction (MI), or stroke in patients with acute coronary syndromes (ACS), compared with clopidogrel and aspirin. However, ticagrelor increased the incidence of dyspnoea, which may lead clinicians to withhold ticagrelor from COPD patients.…”

Section: Introductionmentioning

confidence: 99%

Impact of chronic obstructive pulmonary disease and dyspnoea on clinical outcomes in ticagrelor treated patients undergoing percutaneous coronary intervention in the randomized GLOBAL LEADERS trial

Tomaniak

Chichareon

Takahashi

et al. 2019

European Heart Journal - Cardiovascular Pharmacotherapy

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Aims To evaluate long-term safety and efficacy of ticagrelor monotherapy in patients undergoing percutaneous coronary interventions (PCIs) in relation to chronic obstructive pulmonary disease (COPD) at baseline and the occurrence of dyspnoea reported as adverse event (AE) that may lead to treatment non-adherence. Methods and results This is a non-prespecified, post hoc analysis of the randomized GLOBAL LEADERS trial (n = 15 991), comparing the experimental strategy of 23-month ticagrelor monotherapy following 1-month dual antiplatelet therapy (DAPT) after PCI with the reference strategy of 12-month DAPT followed by 12-month aspirin monotherapy. Impact of COPD and dyspnoea AE (as a time-dependent covariate) on clinical outcomes was evaluated up to 2 years. The primary endpoint was a 2-year all-cause mortality or non-fatal, centrally adjudicated, new Q-wave myocardial infarction. The presence of COPD (n = 832) was the strongest clinical predictor of 2-year all-cause mortality after PCI [hazard ratio (HR) 2.84; 95% confidence interval (CI) 2.21–3.66; P adjusted = 0.001] in this cohort (n = 15 991). No differential treatment effects on 2-year clinical outcomes were found in patients with and without COPD (primary endpoint: HR 0.88; 95% CI 0.58–1.35; P = 0.562; P int = 0.952). Overall, at 2 years dyspnoea was reported as an AE in 2101 patients, more frequently among COPD patients, irrespective of treatment allocation (27.2% in experimental arm vs. 14.5% in reference arm, P = 0.001). Its occurrence was not associated with a higher rate of the primary endpoint (P adjusted = 0.640) in the experimental vs. the reference arm. Conclusion In this exploratory analysis, COPD negatively impacted long-term prognosis after PCI. Despite higher incidence of dyspnoea in the experimental arm, in particular among COPD patients, the safety of the experimental treatment strategy appeared not to be affected. Clinical trial registration unique identifier NCT01813435.

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Major adverse cardiac events and mortality in chronic obstructive pulmonary disease following percutaneous coronary intervention: a systematic review and meta-analysis

Cited by 17 publications

References 19 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>

In‐hospital outcomes of percutaneous mitral valve repair in patients with chronic obstructive pulmonary disease: insights from the national inpatient sample database

Impact of chronic obstructive pulmonary disease and dyspnoea on clinical outcomes in ticagrelor treated patients undergoing percutaneous coronary intervention in the randomized GLOBAL LEADERS trial

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