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Original Research: COPD |

Increased Adverse Events After Percutaneous Coronary Intervention in Patients With COPDPercutaneous Coronary Intervention Adverse Events: Insights From the National Heart, Lung, and Blood Institute Dynamic Registry

Jonathan R. Enriquez, MD; Shailja V. Parikh, MD; Faith Selzer, PhD; Alice K. Jacobs, MD; Oscar Marroquin, MD; Suresh Mulukutla, MD; Vankeepuram Srinivas, MD; Elizabeth M. Holper, MD, MPH
Author and Funding Information

From the Division of Cardiology (Drs Enriquez, Parikh, and Holper), University of Texas Southwestern Medical Center, Dallas, TX; the Department of Epidemiology (Dr Selzer) and Division of Cardiology (Drs Marroquin and Mulukutla), University of Pittsburgh, Pittsburgh, PA; the Division of Cardiology (Dr Jacobs), Boston University Medical Center, Boston, MA; and the Division of Cardiology (Dr Srinivas), Jack D. Weiler/Montefiore Medical Center, Bronx, NY.

Correspondence to: Elizabeth Holper, MD, MPH, University of Texas Southwestern Medical Center, Division of Cardiology, 5323 Harry Hines Blvd, Dallas, TX 75390-8837; e-mail: Elizabeth.Holper@UTSouthwestern.edu


For editorial comment see page 569

Funding/Support: This study was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health [Grant HL-33292].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;140(3):604-610. doi:10.1378/chest.10-2644
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Background:  Previous studies have demonstrated that patients with COPD are at higher risk for death after percutaneous coronary intervention (PCI), but other clinical outcomes and possible associations with adverse events have not been described.

Methods:  Using waves 1 through 5 (1999-2006) of the National Heart, Lung, and Blood Institute Dynamic Registry, patients with COPD (n = 860) and without COPD (n = 10,048) were compared. Baseline demographics, angiographic characteristics, and in-hospital and 1-year adverse events were compared.

Results:  Patients with COPD were older (mean age 66.8 vs 63.2 years, P < .001), more likely to be women, and more likely to have a history of diabetes, prior myocardial infarction, peripheral arterial disease, renal disease, and smoking. Patients with COPD also had a lower mean ejection fraction (49.1% vs 53.0%, P < .001) and a greater mean number of significant lesions (3.2 vs 3.0, P = .006). Rates of in-hospital death (2.2% vs 1.1%, P = .003) and major entry site complications (6.6% vs 4.2%, P < .001) were higher in pulmonary patients. At discharge, pulmonary patients were significantly less likely to be prescribed aspirin (92.4% vs 95.3%, P < .001), β-blockers (55.7% vs 76.2%, P < .001), and statins (60.0% vs 66.8%, P < .001). After adjustment, patients with COPD had significantly increased risk of death (hazard ratio [HR] = 1.30, 95% CI = 1.01-1.67) and repeat revascularization (HR = 1.22, 95% CI = 1.02-1.46) at 1 year, compared with patients without COPD.

Conclusions:  COPD is associated with higher mortality rates and repeat revascularization within 1 year after PCI. These higher rates of adverse outcomes may be associated with lower rates of guideline-recommended class 1 medications prescribed at discharge.

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