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Outcome of patients with chronic obstructive pulmonary disease and severe coronary artery disease who had a coronary artery bypass graft or a percutaneous coronary intervention.
Eur J Cardiothorac Surg. 2017 Nov 01; 52(5):930-936.EJ

Abstract

OBJECTIVES

Patients with chronic obstructive pulmonary disease (COPD) who also have acute coronary syndromes are a high-risk population with a high mortality rate. Little is known about these patients following coronary artery bypass grafting (CABG).

METHODS

Patients presenting with acute coronary syndromes between 2006 and 2014 with an angiogram showing 3-vessel disease or left main coronary artery involvement who were treated with CABG or percutaneous coronary intervention (PCI) only were included from the nationwide SWEDEHEART registry. Patients were stratified according to COPD status and compared with regard to outcome. The primary end-point was the 5-year mortality rate; secondary outcomes were the 30-day mortality rate and in-hospital complications after CABG.

RESULTS

We identified 6985 patients in the population who had CABG (COPD prevalence = 8.0%) and 14 209 who had PCI only (COPD = 8.2%). Patients with COPD were older and had more comorbidities than patients without COPD. The 5-year mortality rate was nearly doubled in patients with COPD versus patients without COPD (CABG: 27.2% vs 14.5%, P < 0.001; PCI only: 50.1% vs 29.1%, P < 0.001). After adjusting for age, sex and comorbidities, patients with COPD in both CABG-treated [hazard ratio = 1.52 (1.25-1.86), P < 0.001] and PCI-treated populations still had a significantly higher 5-year mortality rate. COPD was also independently associated with significantly more postoperative infections in need of antibiotics [odds ratio = 1.48 (1.07-2.04), P = 0.017] and pneumonia [odds ratio = 2.21 (1.39-3.52), P = 0.001].

CONCLUSIONS

Patients with COPD presenting with acute coronary syndromes and severe coronary artery disease are a high-risk population following CABG or PCI only, with higher risk of long-term and short-term death and postoperative infections. Preventive measures, including careful monitoring for signs of infection and prompt antibiotic treatment when indicated, should be considered.

Authors+Show Affiliations

Department of Cardiology, Clinical Sciences, Lund University and Skåne University Hospital, Lund, Sweden.Department of Cardiothoracic Surgery, Clinical Sciences, Lund University and Skåne University Hospital, Lund, Sweden.Uppsala Clinical Research Center and Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden.Department of Medicine, Huddinge, Karolinska Institute, Stockholm, Sweden. Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden. Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.Department of Cardiology, Clinical Sciences, Lund University and Skåne University Hospital, Lund, Sweden.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29088423

Citation

Andell, Pontus, et al. "Outcome of Patients With Chronic Obstructive Pulmonary Disease and Severe Coronary Artery Disease Who Had a Coronary Artery Bypass Graft or a Percutaneous Coronary Intervention." European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery, vol. 52, no. 5, 2017, pp. 930-936.
Andell P, Sjögren J, Batra G, et al. Outcome of patients with chronic obstructive pulmonary disease and severe coronary artery disease who had a coronary artery bypass graft or a percutaneous coronary intervention. Eur J Cardiothorac Surg. 2017;52(5):930-936.
Andell, P., Sjögren, J., Batra, G., Szummer, K., & Koul, S. (2017). Outcome of patients with chronic obstructive pulmonary disease and severe coronary artery disease who had a coronary artery bypass graft or a percutaneous coronary intervention. European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery, 52(5), 930-936. https://doi.org/10.1093/ejcts/ezx219
Andell P, et al. Outcome of Patients With Chronic Obstructive Pulmonary Disease and Severe Coronary Artery Disease Who Had a Coronary Artery Bypass Graft or a Percutaneous Coronary Intervention. Eur J Cardiothorac Surg. 2017 Nov 1;52(5):930-936. PubMed PMID: 29088423.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outcome of patients with chronic obstructive pulmonary disease and severe coronary artery disease who had a coronary artery bypass graft or a percutaneous coronary intervention. AU - Andell,Pontus, AU - Sjögren,Johan, AU - Batra,Gorav, AU - Szummer,Karolina, AU - Koul,Sasha, PY - 2016/11/29/received PY - 2017/04/14/accepted PY - 2017/11/1/entrez PY - 2017/11/1/pubmed PY - 2018/6/23/medline KW - Chronic obstructive pulmonary disease KW - Coronary artery bypass grafting KW - Infections KW - Mortality KW - Percutaneous coronary intervention SP - 930 EP - 936 JF - European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery JO - Eur J Cardiothorac Surg VL - 52 IS - 5 N2 - OBJECTIVES: Patients with chronic obstructive pulmonary disease (COPD) who also have acute coronary syndromes are a high-risk population with a high mortality rate. Little is known about these patients following coronary artery bypass grafting (CABG). METHODS: Patients presenting with acute coronary syndromes between 2006 and 2014 with an angiogram showing 3-vessel disease or left main coronary artery involvement who were treated with CABG or percutaneous coronary intervention (PCI) only were included from the nationwide SWEDEHEART registry. Patients were stratified according to COPD status and compared with regard to outcome. The primary end-point was the 5-year mortality rate; secondary outcomes were the 30-day mortality rate and in-hospital complications after CABG. RESULTS: We identified 6985 patients in the population who had CABG (COPD prevalence = 8.0%) and 14 209 who had PCI only (COPD = 8.2%). Patients with COPD were older and had more comorbidities than patients without COPD. The 5-year mortality rate was nearly doubled in patients with COPD versus patients without COPD (CABG: 27.2% vs 14.5%, P < 0.001; PCI only: 50.1% vs 29.1%, P < 0.001). After adjusting for age, sex and comorbidities, patients with COPD in both CABG-treated [hazard ratio = 1.52 (1.25-1.86), P < 0.001] and PCI-treated populations still had a significantly higher 5-year mortality rate. COPD was also independently associated with significantly more postoperative infections in need of antibiotics [odds ratio = 1.48 (1.07-2.04), P = 0.017] and pneumonia [odds ratio = 2.21 (1.39-3.52), P = 0.001]. CONCLUSIONS: Patients with COPD presenting with acute coronary syndromes and severe coronary artery disease are a high-risk population following CABG or PCI only, with higher risk of long-term and short-term death and postoperative infections. Preventive measures, including careful monitoring for signs of infection and prompt antibiotic treatment when indicated, should be considered. SN - 1873-734X UR - https://www.unboundmedicine.com/medline/citation/29088423/Outcome_of_patients_with_chronic_obstructive_pulmonary_disease_and_severe_coronary_artery_disease_who_had_a_coronary_artery_bypass_graft_or_a_percutaneous_coronary_intervention_ L2 - https://academic.oup.com/ejcts/article-lookup/doi/10.1093/ejcts/ezx219 DB - PRIME DP - Unbound Medicine ER -