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The association between recent hospitalized COPD exacerbations and adverse outcomes after percutaneous coronary intervention: a nationwide cohort study.
Int J Chron Obstruct Pulmon Dis. 2019; 14:169-179.IJ

Abstract

Purpose

COPD is associated with coronary artery disease, and exacerbations are major events in COPD. However, the impact of recent hospitalized exacerbations on outcomes of percutaneous coronary intervention (PCI) remains underdetermined.

Patients and methods

Using the National Health Insurance Research Database of Taiwan, we identified 215,275 adult patients who underwent first-time PCI between 2000 and 2012. Among these patients, 15,485 patients had COPD. The risks of hospital mortality, overall mortality, and adverse cardiovascular outcomes after PCI (ie, ischemic events, repeat revascularization, cerebrovascular events, and major adverse cardiac and cerebrovascular events [MACCEs]) in relation to COPD, and the frequency and timing of recent hospitalized exacerbations within 1 year before PCI were estimated.

Results

COPD was independently associated with increased risks of hospital mortality, overall mortality, ischemic events, cerebrovascular events, and MACCE during follow-up after PCI. Among cerebrovascular events, ischemic rather than hemorrhagic stroke was more likely to occur. In COPD patients, recent hospitalized exacerbations further increased the risks of overall mortality, ischemic events, and MACCE following PCI. Notably, patients with more frequent or more recent hospitalized exacerbations had a trend toward higher risks of these adverse events (all P-values for trend <0.0001), especially those with ≥2 exacerbations within 1 year or any exacerbation within 1 month before PCI.

Conclusion

Integrated care is urgently needed to alleviate COPD-related morbidity and mortality after PCI, especially for patients with a recent hospitalized exacerbation.

Authors+Show Affiliations

Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan, cyli99@mail.ncku.edu.tw. Graduate Institute of Food Safety, College of Agriculture and Nature Resources, National Chung Hsing University, Taichung, Taiwan.Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan, d303878@mail.hosp.ncku.edu.tw.Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan, d303878@mail.hosp.ncku.edu.tw.Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan, cyli99@mail.ncku.edu.tw. Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan, cyli99@mail.ncku.edu.tw.Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan, d303878@mail.hosp.ncku.edu.tw.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30655664

Citation

Lin, Wei-Chieh, et al. "The Association Between Recent Hospitalized COPD Exacerbations and Adverse Outcomes After Percutaneous Coronary Intervention: a Nationwide Cohort Study." International Journal of Chronic Obstructive Pulmonary Disease, vol. 14, 2019, pp. 169-179.
Lin WC, Chen CW, Lu CL, et al. The association between recent hospitalized COPD exacerbations and adverse outcomes after percutaneous coronary intervention: a nationwide cohort study. Int J Chron Obstruct Pulmon Dis. 2019;14:169-179.
Lin, W. C., Chen, C. W., Lu, C. L., Lai, W. W., Huang, M. H., Tsai, L. M., Li, C. Y., & Lai, C. H. (2019). The association between recent hospitalized COPD exacerbations and adverse outcomes after percutaneous coronary intervention: a nationwide cohort study. International Journal of Chronic Obstructive Pulmonary Disease, 14, 169-179. https://doi.org/10.2147/COPD.S187345
Lin WC, et al. The Association Between Recent Hospitalized COPD Exacerbations and Adverse Outcomes After Percutaneous Coronary Intervention: a Nationwide Cohort Study. Int J Chron Obstruct Pulmon Dis. 2019;14:169-179. PubMed PMID: 30655664.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The association between recent hospitalized COPD exacerbations and adverse outcomes after percutaneous coronary intervention: a nationwide cohort study. AU - Lin,Wei-Chieh, AU - Chen,Chang-Wen, AU - Lu,Chin-Li, AU - Lai,Wu-Wei, AU - Huang,Min-Hsin, AU - Tsai,Liang-Miin, AU - Li,Chung-Yi, AU - Lai,Chao-Han, Y1 - 2019/01/03/ PY - 2019/1/19/entrez PY - 2019/1/19/pubmed PY - 2019/7/30/medline KW - cardiovascular outcomes KW - chronic obstructive pulmonary disease (COPD) KW - exacerbation KW - percutaneous coronary intervention (PCI) SP - 169 EP - 179 JF - International journal of chronic obstructive pulmonary disease JO - Int J Chron Obstruct Pulmon Dis VL - 14 N2 - Purpose: COPD is associated with coronary artery disease, and exacerbations are major events in COPD. However, the impact of recent hospitalized exacerbations on outcomes of percutaneous coronary intervention (PCI) remains underdetermined. Patients and methods: Using the National Health Insurance Research Database of Taiwan, we identified 215,275 adult patients who underwent first-time PCI between 2000 and 2012. Among these patients, 15,485 patients had COPD. The risks of hospital mortality, overall mortality, and adverse cardiovascular outcomes after PCI (ie, ischemic events, repeat revascularization, cerebrovascular events, and major adverse cardiac and cerebrovascular events [MACCEs]) in relation to COPD, and the frequency and timing of recent hospitalized exacerbations within 1 year before PCI were estimated. Results: COPD was independently associated with increased risks of hospital mortality, overall mortality, ischemic events, cerebrovascular events, and MACCE during follow-up after PCI. Among cerebrovascular events, ischemic rather than hemorrhagic stroke was more likely to occur. In COPD patients, recent hospitalized exacerbations further increased the risks of overall mortality, ischemic events, and MACCE following PCI. Notably, patients with more frequent or more recent hospitalized exacerbations had a trend toward higher risks of these adverse events (all P-values for trend <0.0001), especially those with ≥2 exacerbations within 1 year or any exacerbation within 1 month before PCI. Conclusion: Integrated care is urgently needed to alleviate COPD-related morbidity and mortality after PCI, especially for patients with a recent hospitalized exacerbation. SN - 1178-2005 UR - https://www.unboundmedicine.com/medline/citation/30655664/The_association_between_recent_hospitalized_COPD_exacerbations_and_adverse_outcomes_after_percutaneous_coronary_intervention:_a_nationwide_cohort_study_ L2 - https://dx.doi.org/10.2147/COPD.S187345 DB - PRIME DP - Unbound Medicine ER -