PURPOSE: Long-term clinical outcomes in patients with COPD undergoing PCI in the era of drug-eluting stents (DES), glycoprotein (GP) IIb/IIIa inhibitors, and clopidogrel pretreatment have not been well characterized. We compared in-hospital and long-term clinical outcomes in patients who underwent PCI with versus without diagnosis of COPD.
METHODS: Using the 2004/2005 Cornell Angioplasty Registry, we evaluated 2,455 consecutive patients undergoing urgent or elective PCI and compared in-hospital outcomes, 1-year, and long-term mortality. We excluded patients presenting with an ST-elevation MI ≤24 hours, hemodynamic instability/shock, thrombolytic therapy ≤7 days, or renal insufficiency (creatinine ≥4 mg/dL). All-cause mortality was obtained for 100% of patients, with a mean follow-up of 4.4 ± 1.1 years.
RESULTS: Of the 2,455 study patients, 121 patients (4.9%) had COPD, and 2,334 (95.1%) were without COPD. The mean age of the study population was 66.9 years, and 69.3% were men. DES were used in 87% of PCIs, glycoprotein IIb/IIIa inhibitors were used in 53% of patients. The incidence of in-hospital death (1.7% vs. 0.2%, p=0.032), post-procedural MI (9.9% vs. 6.6%, p=0.191), and MACE including death, stroke, emergent CABG/PCI, and MI (11.6% vs. 6.9%, p=0.066) were non-significantly greater in patients with vs. without COPD, respectively. The incidence of 1-year mortality (9.9% vs. 2.9%, p<0.001) and long-term Kaplan-Meier mortality (21.5% vs. 11.2%, p<0.001) were greater in patients with COPD vs. without COPD, respectively. After adjustment with a multivariate Cox regression analysis, COPD status was an independent predictor of 1-year (HR 3.45, 95%CI 1.76-6.76, p<0.001) and long-term mortality (HR 1.77, 95%CI 1.16-2.70, p=0.008).
CONCLUSIONS: In contemporary PCI utilizing DES, glycoprotein IIb/IIIa inhibitors and clopidogrel, patients with COPD have a higher in-hospital and 4-year mortality compared to patients without COPD.
CLINICAL IMPLICATIONS: Patients with COPD may represent a higher risk group, because they were more likely to present with acute congestive heart failure. Pulmonary evaluation and close monitoring of the respiratory status of patients with COPD may be important to improve peri-procedural outcomes following PCI.
DISCLOSURE: The following authors have nothing to disclose: Kirana Gudi, Lindsay Lief, Madhav Gudi, Dmitriy Feldman
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