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Kibbler J, Wade C, Mussell G, Ripley DP, Bourke SC, Steer J. Systematic review and meta-analysis of prevalence of undiagnosed major cardiac comorbidities in COPD. ERJ Open Res 2023; 9:00548-2023. [PMID: 38020568 PMCID: PMC10680032 DOI: 10.1183/23120541.00548-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 09/18/2023] [Indexed: 12/01/2023] Open
Abstract
Background It is often stated that heart disease is underdiagnosed in COPD. Evidence for this statement comes from primary studies, but these have not been synthesised to provide a robust estimate of the burden of undiagnosed heart disease. Methods A systematic review of studies using active diagnostic techniques to establish the prevalence of undiagnosed major cardiac comorbidities in patients with COPD was carried out. MEDLINE, Embase, Scopus and Web of Science were searched for terms relating to heart failure (specifically, left ventricular systolic dysfunction (LVSD), coronary artery disease (CAD) and atrial fibrillation), relevant diagnostic techniques and COPD. Studies published since 1980, reporting diagnosis rates using recognised diagnostic criteria in representative COPD populations not known to have heart disease were included. Studies were classified by condition diagnosed, diagnostic threshold used and whether participants had stable or exacerbated COPD. Random-effects meta-analysis of prevalence was conducted where appropriate. Results In general, prevalence estimates for undiagnosed cardiac comorbidities in COPD had broad confidence intervals, with significant study heterogeneity. Most notably, a prevalence of undiagnosed LVSD of 15.8% (11.1-21.1%) was obtained when defined as left ventricular ejection fraction <50%. Undiagnosed CAD was found in 2.3-18.0% of COPD patients and atrial fibrillation in 1.4% (0.3-3.5%). Conclusion Further studies using recent diagnostic advances, and investigating therapeutic interventions for patients with COPD and heart disease are needed.
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Affiliation(s)
- Joseph Kibbler
- Northumbria Healthcare NHS Foundation Trust, Respiratory Medicine, North Shields, UK
- Newcastle University, Translation and Clinical Research Institute, Newcastle upon Tyne, UK
| | - Clare Wade
- Northumbria University, Sport, Exercise and Rehabilitation, Newcastle upon Tyne, UK
| | - Grace Mussell
- Northumbria Healthcare NHS Foundation Trust, Respiratory Medicine, North Shields, UK
| | - David P. Ripley
- Northumbria Healthcare NHS Foundation Trust, Respiratory Medicine, North Shields, UK
| | - Stephen C. Bourke
- Northumbria Healthcare NHS Foundation Trust, Respiratory Medicine, North Shields, UK
- Newcastle University, Translation and Clinical Research Institute, Newcastle upon Tyne, UK
| | - John Steer
- Northumbria Healthcare NHS Foundation Trust, Respiratory Medicine, North Shields, UK
- Northumbria University, Sport, Exercise and Rehabilitation, Newcastle upon Tyne, UK
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Ferreira EJP, Cardoso LVSDC, de Matos CJO, Mota IL, Lira JMC, Lopes MEG, Santos GV, Dória Almeida ML, Aguiar-Oliveira MH, Sousa ACS, de Melo EV, Oliveira JLM. Cardiovascular Prognosis of Subclinical Chronic Obstructive Pulmonary Disease in Patients with Suspected or Confirmed Coronary Artery Disease. Int J Chron Obstruct Pulmon Dis 2023; 18:1899-1908. [PMID: 37662489 PMCID: PMC10474840 DOI: 10.2147/copd.s410416] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 08/06/2023] [Indexed: 09/05/2023] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) worsens prognosis in patients with coronary artery disease (CAD). However, the cardiovascular prognosis in patients with stable or mildly symptomatic COPD remains unclear. Here, we sought to determine the long-term cardiovascular events in patients with subclinical or early-stage COPD with concomitant CAD. Methods This was a longitudinal analytical study involving 117 patients with suspected or established CAD who underwent assessment of pulmonary function by spirometry and who were followed up for six years (March 2015-January 2021). The patients were divided into two groups, one comprising COPD (n=44) and the other non-COPD (n=73) patients. Cox regression was used to evaluate the association between COPD and cardiovascular events, with adjustment for the established CAD risk factors, and the effect size was measured by the Cohen test. Results COPD patients were older (p=0.028), had a greater frequency of diabetes (p=0.026), were more likely to be smokers (p<0.001), and had higher modified Medical Research Council scores (p<0.001). There was no difference between the groups regarding gender, body mass index, hypertension, dyslipidemia, family history of CAD, and type of angina. CAD frequency and the proportion of patients with severe and multivessel CAD were significantly higher among COPD than among non-COPD patients (all p<0.001). At six-year follow-up, patients with COPD were more likely to have experienced adverse cardiovascular events than those without COPD (p<0.001; effect size, 0.720). After adjusting for established CAD risk factors, COPD occurrence remained an independent predictor for long-term adverse cardiovascular events (OR: 5.13; 95% CI: 2.29-11.50; p<0.0001). Conclusion COPD was associated with increased severity of coronary lesions and a greater number of adverse cardiovascular events in patients with suspected or confirmed CAD. COPD remained a predictor of long-term cardiovascular events in stable patients with subclinical or early-stage of COPD, independently of the established CAD risk factors.
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Affiliation(s)
- Eduardo José Pereira Ferreira
- Department of Medicine, Federal University of Sergipe, Lagarto, 49400-000, Brazil
- Postgraduate Program in Health Sciences, Federal University of Sergipe, Aracaju, 49100-000, Brazil
- University Hospital, Federal University of Sergipe, Aracaju, 49100-000, Brazil
- São Lucas Clinic and Hospital- Rede D’Or São Luiz, Aracaju, 49060-676, Brazil
| | - Lucas Villar Shan de Carvalho Cardoso
- University Hospital, Federal University of Sergipe, Aracaju, 49100-000, Brazil
- Department of Medicine, Federal University of Sergipe, Aracaju, 49100-000, Brazil
| | | | - Igor Larchert Mota
- University Hospital, Federal University of Sergipe, Aracaju, 49100-000, Brazil
- São Lucas Clinic and Hospital- Rede D’Or São Luiz, Aracaju, 49060-676, Brazil
| | - Juliana Maria Chianca Lira
- University Hospital, Federal University of Sergipe, Aracaju, 49100-000, Brazil
- Department of Medicine, Federal University of Sergipe, Aracaju, 49100-000, Brazil
| | - Mayara Evelyn Gomes Lopes
- University Hospital, Federal University of Sergipe, Aracaju, 49100-000, Brazil
- Department of Medicine, Federal University of Sergipe, Aracaju, 49100-000, Brazil
| | - Giulia Vieira Santos
- University Hospital, Federal University of Sergipe, Aracaju, 49100-000, Brazil
- Department of Medicine, Federal University of Sergipe, Aracaju, 49100-000, Brazil
| | - Maria Luiza Dória Almeida
- Postgraduate Program in Health Sciences, Federal University of Sergipe, Aracaju, 49100-000, Brazil
- University Hospital, Federal University of Sergipe, Aracaju, 49100-000, Brazil
- Department of Medicine, Federal University of Sergipe, Aracaju, 49100-000, Brazil
| | - Manuel Herminio Aguiar-Oliveira
- Postgraduate Program in Health Sciences, Federal University of Sergipe, Aracaju, 49100-000, Brazil
- University Hospital, Federal University of Sergipe, Aracaju, 49100-000, Brazil
- Department of Medicine, Federal University of Sergipe, Aracaju, 49100-000, Brazil
| | - Antônio Carlos Sobral Sousa
- Postgraduate Program in Health Sciences, Federal University of Sergipe, Aracaju, 49100-000, Brazil
- University Hospital, Federal University of Sergipe, Aracaju, 49100-000, Brazil
- São Lucas Clinic and Hospital- Rede D’Or São Luiz, Aracaju, 49060-676, Brazil
- Department of Medicine, Federal University of Sergipe, Aracaju, 49100-000, Brazil
| | - Enaldo Vieira de Melo
- University Hospital, Federal University of Sergipe, Aracaju, 49100-000, Brazil
- Department of Medicine, Federal University of Sergipe, Aracaju, 49100-000, Brazil
| | - Joselina Luzia Menezes Oliveira
- Postgraduate Program in Health Sciences, Federal University of Sergipe, Aracaju, 49100-000, Brazil
- University Hospital, Federal University of Sergipe, Aracaju, 49100-000, Brazil
- São Lucas Clinic and Hospital- Rede D’Or São Luiz, Aracaju, 49060-676, Brazil
- Department of Medicine, Federal University of Sergipe, Aracaju, 49100-000, Brazil
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Li Y, Zheng H, Yan W, Cao N, Yan T, Zhu H, Bao H. The impact of chronic obstructive pulmonary disease on the prognosis outcomes of patients with percutaneous coronary intervention or coronary artery bypass grafting: A meta-analysis. Heart Lung 2023; 60:8-14. [PMID: 36868093 DOI: 10.1016/j.hrtlng.2023.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/17/2023] [Accepted: 02/19/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND Coronary artery disease (CAD) is one of the main types of cardiovascular disease and is characterized by myocardial ischemia as a result of narrowing of the coronary arteries. OBJECTIVE To evaluate the impact of chronic obstructive pulmonary disease (COPD) on outcomes in patients with CAD treated by percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). METHODS We searched PubMed, Embase, Web of Science, and Cochrane Library for observational studies and post-hoc analyses of randomized controlled trials published before Jan 20, 2022, in English. Adjusted odds ratios (ORs), risk ratios (RRs), and hazard ratios (HRs) for short-term outcomes (in-hospital and 30-day all-cause mortality) and long-term outcomes (all-cause mortality, cardiac death, major adverse cardiac events) were extracted or transformed. RESULTS Nineteen studies were included. The risk of short-term all-cause mortality was significantly higher in patients with COPD than in those without COPD (RR 1.42, 95% CI 1.05-1.93), as were the risks of long-term all-cause mortality (RR 1.68, 95% CI 1.50-1.88) and long-term cardiac mortality (HR 1.84, 95% CI 1.41-2.41). There was no significant between-group difference in the long-term revascularization rate (HR 1.01, 95% CI 0.99-1.04) or in short-term and long-term stroke rates (OR 0.89, 95% CI 0.58-1.37 and HR 1.38, 95% CI 0.97-1.95). Operation significantly affected heterogeneity and combined results for long-term mortality (CABG, HR 1.32, 95% CI 1.04-1.66; PCI, HR 1.84, 95% CI 1.58-2.13). CONCLUSIONS COPD was independently associated with poor outcomes after PCI or CABG after adjustment for confounders.
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Affiliation(s)
- Yanqi Li
- School of Public Health, Inner Mongolia Medical University, Hohhot, China
| | - Huiqiu Zheng
- School of Public Health, Inner Mongolia Medical University, Hohhot, China
| | - Wenyan Yan
- School of Public Health, Inner Mongolia Medical University, Hohhot, China
| | - Ning Cao
- School of Public Health, Inner Mongolia Medical University, Hohhot, China
| | - Tao Yan
- School of Public Health, Inner Mongolia Medical University, Hohhot, China
| | - Hao Zhu
- School of Public Health, Inner Mongolia Medical University, Hohhot, China
| | - Han Bao
- School of Public Health, Inner Mongolia Medical University, Hohhot, China.
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De Luca G, Nardin M, Algowhary M, Uguz B, Oliveira DC, Ganyukov V, Zimbakov Z, Cercek M, Okkels Jensen L, Loh PH, Calmac L, Roura Ferrer G, Quadros A, Milewski M, Scotto di Uccio F, von Birgelen C, Versaci F, Ten Berg J, Casella G, Wong Sung Lung A, Kala P, Díez Gil JL, Carrillo X, Dirksen M, Becerra-Munoz VM, Lee MKY, Arifa Juzar D, de Moura Joaquim R, Paladino R, Milicic D, Davlouros P, Bakraceski N, Zilio F, Donazzan L, Kraaijeveld A, Galasso G, Lux A, Marinucci L, Guiducci V, Menichelli M, Scoccia A, Yamac AH, Ugur Mert K, Flores Rios X, Kovarnik T, Kidawa M, Moreu J, Flavien V, Fabris E, Martínez-Luengas IL, Boccalatte M, Bosa Ojeda F, Arellano-Serrano C, Caiazzo G, Cirrincione G, Kao HL, Sanchis Forés J, Vignali L, Pereira H, Manzo S, Ordoñez S, Özkan AA, Scheller B, Lehtola H, Teles R, Mantis C, Antti Y, Brum Silveira JA, Zoni R, Bessonov I, Savonitto S, Kochiadakis G, Alexopoulos D, Uribe CE, Kanakakis J, Faurie B, Gabrielli G, Gutierrez Barrios A, Bachini JP, Rocha A, Tam FCC, Rodriguez A, Lukito AA, Saint-Joy V, Pessah G, Tuccillo A, Cortese G, Parodi G, Bouraghda MA, Kedhi E, Lamelas P, Suryapranata H, Verdoia M. Impact of chronic obstructive pulmonary disease on short-term outcome in patients with ST-elevation myocardial infarction during COVID-19 pandemic: insights from the international multicenter ISACS-STEMI registry. Respir Res 2022; 23:207. [PMID: 35971173 PMCID: PMC9376902 DOI: 10.1186/s12931-022-02128-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 05/02/2022] [Indexed: 11/10/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is projected to become the third cause of mortality worldwide. COPD shares several pathophysiological mechanisms with cardiovascular disease, especially atherosclerosis. However, no definite answers are available on the prognostic role of COPD in the setting of ST elevation myocardial infarction (STEMI), especially during COVID-19 pandemic, among patients undergoing primary angioplasty, that is therefore the aim of the current study. Methods In the ISACS-STEMI COVID-19 registry we included retrospectively patients with STEMI treated with primary percutaneous coronary intervention (PCI) between March and June of 2019 and 2020 from 109 high-volume primary PCI centers in 4 continents. Results A total of 15,686 patients were included in this analysis. Of them, 810 (5.2%) subjects had a COPD diagnosis. They were more often elderly and with a more pronounced cardiovascular risk profile. No preminent procedural dissimilarities were noticed except for a lower proportion of dual antiplatelet therapy at discharge among COPD patients (98.9% vs. 98.1%, P = 0.038). With regards to short-term fatal outcomes, both in-hospital and 30-days mortality occurred more frequently among COPD patients, similarly in pre-COVID-19 and COVID-19 era. However, after adjustment for main baseline differences, COPD did not result as independent predictor for in-hospital death (adjusted OR [95% CI] = 0.913[0.658–1.266], P = 0.585) nor for 30-days mortality (adjusted OR [95% CI] = 0.850 [0.620–1.164], P = 0.310). No significant differences were detected in terms of SARS-CoV-2 positivity between the two groups. Conclusion This is one of the largest studies investigating characteristics and outcome of COPD patients with STEMI undergoing primary angioplasty, especially during COVID pandemic. COPD was associated with significantly higher rates of in-hospital and 30-days mortality. However, this association disappeared after adjustment for baseline characteristics. Furthermore, COPD did not significantly affect SARS-CoV-2 positivity. Trial registration number: NCT 04412655 (2nd June 2020).
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Affiliation(s)
- Giuseppe De Luca
- Division of Clinical and Experimental Cardiology, AOU Sassari, Sassari, Italy. .,University of Sassari, Sassari, Italy.
| | - Matteo Nardin
- Third Medicine Division, ASST Spedali Civili, Brescia, Italy
| | - Magdy Algowhary
- Division of Cardiology, Assiut University Heart Hospital, Assiut University, Asyut, Egypt
| | - Berat Uguz
- Division of Cardiology, Bursa City Hospital, Bursa, Turkey
| | - Dinaldo C Oliveira
- Pronto de Socorro Cardiologico Prof. Luis Tavares, Centro PROCAPE, Federal University of Pernambuco, Recife, Brazil
| | - Vladimir Ganyukov
- Department of Heart and Vascular Surgery, State Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | - Zan Zimbakov
- Medical Faculty, University Clinic for Cardiology, Ss' Cyril and Methodius University, Skopje, North Macedonia
| | - Miha Cercek
- Centre for Intensive Internal Medicine, University Medical Centre, Ljubljana, Slovenia
| | | | - Poay Huan Loh
- Department of Cardiology, National University Hospital, Singapore, Singapore
| | - Lucian Calmac
- Clinic Emergency Hospital of Bucharest, Bucharest, Romania
| | - Gerard Roura Ferrer
- Interventional Cardiology Unit, Heart Disease Institute, Hospital Universitari de Bellvitge, Barcelona, Spain
| | | | - Marek Milewski
- Division of Cardiology, Medical University of Silezia, Katowice, Poland
| | | | - Clemens von Birgelen
- Department of Cardiology, Medisch Spectrum Twente, Thoraxcentrum Twente, Enschede, The Netherlands
| | - Francesco Versaci
- Division of Cardiology, Ospedale Santa Maria Goretti Latina, Latina, Italy
| | - Jurrien Ten Berg
- Division of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Gianni Casella
- Division of Cardiology, Ospedale Maggiore Bologna, Bologna, Italy
| | | | - Petr Kala
- University Hospital Brno, Medical Faculty of Masaryk University, Brno, Czech Republic
| | | | | | - Maurits Dirksen
- Division of Cardiology, Northwest Clinics, Alkmaar, The Netherlands
| | | | - Michael Kang-Yin Lee
- Department of Cardiology, Queen Elizabeth Hospital, University of Hong Kong, Yau Ma Tei, Hong Kong
| | - Dafsah Arifa Juzar
- Department of Cardiology and Vascular Medicine, University of Indonesia National Cardiovascular Center "Harapan Kita", Jakarta, Indonesia
| | | | | | - Davor Milicic
- Department of Cardiology, University Hospital Centre, University of Zagreb, Zagreb, Croatia
| | - Periklis Davlouros
- Invasive Cardiology and Congenital Heart Disease, Patras University Hospital, Patras, Greece
| | | | - Filippo Zilio
- Division of Cardiology, Ospedale Santa Chiara di Trento, Trento, Italy
| | - Luca Donazzan
- Division of Cardiology, Ospedale "S. Maurizio" Bolzano, Bolzano, Italy
| | | | - Gennaro Galasso
- Division of Cardiology, Ospedale San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Arpad Lux
- Maastricht University Medical Center, Maastricht, The Netherlands
| | - Lucia Marinucci
- Division of Cardiology, Azienda Ospedaliera "Ospedali Riuniti Marche Nord", Pesaro, Italy
| | - Vincenzo Guiducci
- Division of Cardiology, AUSL-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | | | | | - Aylin Hatice Yamac
- Department of Cardiology, Hospital Bezmialem Vakıf University, İstanbul, Turkey
| | - Kadir Ugur Mert
- Division of Cardiology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | | | | | - Michal Kidawa
- Central Hospital of Medical University of Lodz, Lodz, Poland
| | - Josè Moreu
- Division of Cardiology, Complejo Hospitalario de Toledo, Toledo, Spain
| | - Vincent Flavien
- Division of Cardiology, Center Hospitalier Universitaire de Lille, Lille, France
| | - Enrico Fabris
- Azienda Ospedaliero-Universitaria Ospedali Riuniti Trieste, Trieste, Italy
| | | | - Marco Boccalatte
- Division of Cardiology, Ospedale Santa Maria delle Grazie, Pozzuoli, Italy
| | - Francisco Bosa Ojeda
- Division of Cardiology, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | | | | | | | - Hsien-Li Kao
- Cardiology Division, Department of Internal Medicine, National Taiwan University Hospital, Tapei, Taiwan
| | - Juan Sanchis Forés
- Division of Cardiology, Hospital Clinico Universitario de Valencia, Valencia, Spain
| | - Luigi Vignali
- Interventional Cardiology Unit, Azienda Ospedaliera Sanitaria, Parma, Italy
| | - Helder Pereira
- Cardiology Department, Hospital Garcia de Orta, Pragal, Almada, Portugal
| | - Stephane Manzo
- Division of Cardiology, CHU Lariboisière, AP-HP, Paris VII University, INSERM UMRS 942, Paris, France
| | - Santiago Ordoñez
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | | | - Bruno Scheller
- Division of Cardiology Clinical and Experimental Interventional Cardiology, University of Saarland, Saarbrücken, Germany
| | - Heidi Lehtola
- Division of Cardiology, Oulu University Hospital, Oulu, Finland
| | - Rui Teles
- Division of Cardiology, Hospital de Santa Cruz, CHLO-Nova Medical School, CEDOC, Lisbon, Portugal
| | - Christos Mantis
- Division of Cardiology, Kontantopoulion Hospital, Athens, Greece
| | - Ylitalo Antti
- Division of Cardiology, Heart Centre Turku, Turku, Finland
| | | | - Rodrigo Zoni
- Department of Teaching and Research, Instituto de Cardiología de Corrientes "Juana F. Cabral", Corrientes, Argentina
| | | | | | | | | | - Carlos E Uribe
- Division of Cardiology, Universidad UPB, Universidad CES, Medellin, Colombia
| | - John Kanakakis
- Division of Cardiology, Alexandra Hospital, Athens, Greece
| | - Benjamin Faurie
- Division of Cardiology, Groupe Hospitalier Mutualiste de Grenoble, Grenoble, France
| | - Gabriele Gabrielli
- Interventional Cardiology Unit, Azienda Ospedaliero Universitaria"Ospedali Riuniti", Ancona, Italy
| | | | | | - Alex Rocha
- Department of Cardiology and Cardiovascular Interventions, Instituto Nacional de Cirugía Cardíaca, Montevideo, Uruguay
| | - Frankie Chor-Cheung Tam
- Department of Cardiology, Queen Mary Hospital, University of Hong Kong, Pok Fu Lam, Hong Kong
| | | | - Antonia Anna Lukito
- Cardiovascular Department Pelita, Harapan University/Heart Center Siloam Lippo Village Hospital, Tangerang, Banten, Indonesia
| | | | - Gustavo Pessah
- Division of Cardiology, Hospiatl Cordoba, Cordoba, Argentina
| | | | - Giuliana Cortese
- Department of Statistical Sciences, University of Padova, Padua, Italy
| | - Guido Parodi
- Department of Cardiology, ASL 4 Liguria, Lavagna, Italy
| | | | - Elvin Kedhi
- Division of Cardiology, Hopital Erasmus, Universitè Libre de Bruxelles, Brussels, Belgium
| | - Pablo Lamelas
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Harry Suryapranata
- Division of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Monica Verdoia
- Division of Cardiology, Ospedale degli Infermi, ASL Biella, Ponderano, Italy
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Effects of chronic obstructive pulmonary disease on long-term prognosis of patients with coronary heart disease post-percutaneous coronary intervention. J Geriatr Cardiol 2022; 19:428-434. [PMID: 35845153 PMCID: PMC9248278 DOI: 10.11909/j.issn.1671-5411.2022.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) and cardiovascular diseases are often comorbid conditions, their co-occurrence yields worse outcomes than either condition alone. This study aimed to investigate COPD impacts on the five-year prognosis of patients with coronary heart disease (CHD) after percutaneous coronary intervention (PCI). METHODS Patients with CHD who underwent PCI in 2013 were recruited, and divided into COPD group and non-COPD group. Adverse events occurring among those groups were recorded during the five-year follow-up period after PCI, including all-cause death and cardiogenic death, myocardial infarction, repeated revascularization, as well as stroke and bleeding events. Major adverse cardiac and cerebral events were a composite of all-cause death, myocardial infarction, repeated revascularization and stroke. RESULTS A total of 9843 patients were consecutively enrolled, of which 229 patients (2.3%) had COPD. Compared to non-COPD patients, COPD patients were older, along with poorer estimated glomerular filtration rate and lower left ventricular ejection fraction. Five-year follow-up results showed that incidences of all-cause death and cardiogenic death, as well as major adverse cardiac and cerebral events, for the COPD group were significantly higher than for non-COPD group (10.5% vs. 3.9%, 7.4% vs. 2.3%, and 30.1% vs. 22.6%, respectively). COPD was found under multivariate Cox regression analysis, adjusted for confounding factors, to be an independent predictor of all-cause death [odds ratio (OR) = 1.76, 95% CI: 1.15-2.70, P = 0.009] and cardiogenic death (OR = 2.02, 95% CI: 1.21-3.39, P = 0.007). CONCLUSIONS COPD is an independent predictive factor for clinical mortality, in which CHD patients with COPD are associated with worse prognosis than CHD patients with non-COPD.
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Chung CM, Lin MS, Chang ST, Wang PC, Yang TY, Lin YS. Cardioselective Versus Nonselective β-Blockers After Myocardial Infarction in Adults With Chronic Obstructive Pulmonary Disease. Mayo Clin Proc 2022; 97:531-546. [PMID: 35135688 DOI: 10.1016/j.mayocp.2021.07.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 03/30/2021] [Accepted: 07/01/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To investigate which types of β-blockers have better efficacy and safety profiles in patients with concomitant chronic obstructive pulmonary disease (COPD) and myocardial infarction (MI) to address concerns about use of β-blockers in COPD. METHODS We identified 65,699 patients with COPD prescribed β-blockers after first MI in the Taiwan National Health Insurance Research Database between January 1, 2001, and December 31, 2013. Comparisons were performed using the inverse probability of treatment weighting method. The primary outcome was all-cause mortality; secondary outcomes were heart failure hospitalization, major adverse cardiac and cerebrovascular event (MACCE), and major adverse pulmonary event (MAPE). RESULTS A total of 14,789 patients prescribed β-blockers were enrolled, of whom 7247 (49.0%) used cardioselective β-blockers and 7542 (51.0%) used nonselective β-blockers. The cardioselective group had lower incidence rates of mortality (hazard ratio [HR], 0.93; 95% CI, 0.89 to 0.96), MACCE (HR, 0.96; 95% CI, 0.93 to 0.998), heart failure hospitalization (subdistribution HR, 0.84; 95% CI, 0.78 to 0.91), and MAPE (HR, 0.94; 95% CI, 0.90 to 0.98) at the end of follow-up after weighting. Similar results were also found in subgroup analysis between those prescribed bisoprolol and those prescribed carvedilol. CONCLUSION Patients prescribed a cardioselective β-blocker may have a lower incidence of all-cause mortality, MACCE, heart failure hospitalization, and MAPE than those prescribed a nonselective β-blocker. Cardioselective β-blocker treatment during hospitalization and continuing after discharge appears to be superior to nonselective β-blocker treatment in patients with COPD after MI.
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Affiliation(s)
- Chang-Min Chung
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan County, Taiwan; Division of Cardiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Ming-Shyan Lin
- Division of Cardiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Shih-Tai Chang
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan County, Taiwan; Division of Cardiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Po-Chang Wang
- Division of Cardiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Teng-Yao Yang
- Division of Cardiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yu-Sheng Lin
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan County, Taiwan; Division of Cardiology, Chang Gung Memorial Hospital, Chiayi, Taiwan.
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Deshmukh K, Khanna A. The Burden of Chronic Obstructive Pulmonary Disease in Cardiovascular Diseases: A Non-Western Perspective. Tuberc Respir Dis (Seoul) 2021; 84:167-170. [PMID: 33596375 PMCID: PMC8010418 DOI: 10.4046/trd.2020.0151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 02/16/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
| | - Arjun Khanna
- Department of Pulmonary Medicine, Yashoda Hospital, Delhi, India
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Goedemans L, Bax JJ, Delgado V. COPD and acute myocardial infarction. Eur Respir Rev 2020; 29:29/156/190139. [PMID: 32581139 DOI: 10.1183/16000617.0139-2019] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 12/06/2019] [Indexed: 12/31/2022] Open
Abstract
COPD is strongly associated with cardiovascular disease, in particular acute myocardial infarction (AMI). Besides shared risk factors, COPD-related factors, such as systemic inflammation and hypoxia, underlie the pathophysiological interaction between COPD and AMI. The prevalence of COPD amongst AMI populations ranges from 7% to 30%, which is possibly even an underestimation due to underdiagnoses of COPD in general. Following the acute event, patients with COPD have an increased risk of mortality, heart failure and arrhythmias during follow-up. Adequate risk stratification can be performed using various imaging techniques, evaluating cardiac size and function after AMI. Conventional imaging techniques such as echocardiography and cardiac magnetic resonance imaging have already indicated impaired cardiac function in patients with COPD without known cardiovascular disease. Advanced imaging techniques such as speckle-tracking echocardiography and T1 mapping could provide more insight into cardiac structure and function after AMI and have proven to be of prognostic value. Future research is required to better understand the impact of AMI on patients with COPD in order to provide effective secondary prevention. The present article summarises the current knowledge on the pathophysiologic factors involved in the interaction between COPD and AMI, the prevalence and outcomes of AMI in patients with COPD and the role of imaging in the acute phase and risk stratification after AMI in patients with COPD.
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Affiliation(s)
- Laurien Goedemans
- Dept of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jeroen J Bax
- Dept of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Victoria Delgado
- Dept of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
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9
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Alqahtani F, Welle GA, Elsisy MF, Kalra A, Alhajji M, Boubas W, Berzingi C, Alkhouli M. Incidence, Characteristics, and Outcomes of Acute Myocardial Infarction among Patients Admitted with Acute Exacerbation of Chronic Obstructive Lung Disease. COPD 2020; 17:261-268. [PMID: 32366132 DOI: 10.1080/15412555.2020.1757054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The frequency, characteristics and outcomes of acute myocardial infarction (AMI) during exacerbation of chronic obstructive pulmonary disease (COPD) are unknown. Adult patients hospitalized with a principle diagnosis of acute COPD exacerbation were identified using retrospective analysis of the Nationwide Inpatient Sample (NIS) from 2003 to 2016. Patients were stratified into 2-groups with and without a secondary diagnosis of AMI. The study's endpoints were in-hospital morbidity, mortality, and resource utilization. We also assessed the impact of invasive management strategy on the same end-points. We included 6 894 712 hospitalizations, of which 56 515 (0.82%) were complicated with AMIs. Patients with AMI were older, and had higher prevalence of known coronary disease (48.9% vs. 27.4%), atrial fibrillation (23.3% vs. 15.2%), heart failure (47.8% vs. 26.2%), and anemia (20.7% vs. 14.8%) (p < 0.001). Rates of oxygen dependence were similar (16.3% vs. 16.1%, p = 0.24). In 56 486 propensity-matched pairs of patients with and without AMI, mortality was higher in the AMI group (12.1% vs. 2.1%, p < 0.001). Rates of major morbidities, non-home discharge, and cost were all higher in the AMI group. A minority (18.1%) of patients with AMI underwent invasive assessment, and those had lower in-hospital mortality before (4.9% vs. 13.8%) and after (5.0% vs. 10.0%) propensity-score matching (p < 0.001). This lower mortality persisted in a sensitivity analysis accounting for immortal time bias. AMI complicates ∼1% of patients admitted with acute COPD exacerbation, and those have worse outcomes than those without AMI. Invasive management for secondary AMI during acute COPD exacerbation may be associated with improved outcomes but is utilized in <20% of patients.
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Affiliation(s)
- Fahad Alqahtani
- Division of Cardiology, University of Kentucky, Lexington, KY, USA
| | - Garrett A Welle
- Department of Cardiology, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Mohamed F Elsisy
- Department of Cardiology, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Ankur Kalra
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Mohamed Alhajji
- Division of Cardiology, West Virginia University, Morgantown, WV, USA
| | - Wafaa Boubas
- Division of Cardiology, West Virginia University, Morgantown, WV, USA
| | - Chalak Berzingi
- Division of Cardiology, West Virginia University, Morgantown, WV, USA
| | - Mohamad Alkhouli
- Department of Cardiology, Mayo Clinic School of Medicine, Rochester, MN, USA
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10
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The bidirectional relationship between chronic obstructive pulmonary disease and coronary artery disease. Herz 2020; 45:110-117. [DOI: 10.1007/s00059-020-04893-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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11
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Șerban RC, Șuș I, Lakatos EK, Demjen Z, Ceamburu A, Fișcă PC, Somkereki C, Hadadi L, Scridon A. Chronic kidney disease predicts atrial fibrillation in patients with ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention. Acta Cardiol 2019; 74:472-479. [PMID: 30650039 DOI: 10.1080/00015385.2018.1521558] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Atrial fibrillation (AF) often complicates ST-segment elevation myocardial infarction (STEMI). Predictors of AF in this setting include factors related to the acute phase of STEMI and pre-existing conditions. More recently, novel AF predictors have been identified in the general population. We aimed to assess the ability of such novel factors to predict STEMI-related AF.Methods: Data were collected from STEMI patients treated by primary PCI. Factors related to the acute phase of STEMI (Killip class, heart rate, blood pressure on admission, post-PCI TIMI flow), classic (age, hypertension, heart failure, previous myocardial infarction), and more novel (body mass index [BMI], diabetes, chronic kidney disease [CKD], chronic obstructive pulmonary disease [COPD]) AF predictors were evaluated. The ability of these novel factors to predict STEMI-related AF was assessed.Results: Of the 629 studied patients, 10.5% presented STEMI-related AF. AF patients had higher Killip class on admission (p < .0001) and lower post-PCI TIMI flow (p < .01), they were older (p < .0001) and more likely to have a history of heart failure (p = .02) and myocardial infarction (p = .04). BMI, history of diabetes and COPD were similar between patients with and without AF (all p > .05), but CKD was more common in AF patients (p < .0001). In multiple regression analysis, CKD remained a strong independent predictor of STEMI-related AF (p < .0001).Conclusion: Irrespective of other factors, CKD was associated with increased risk of STEMI-related AF. CKD could be used to identify patients who will develop AF in this setting and who would benefit from closer follow-up and more intensive prophylactic strategies.
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Affiliation(s)
- Răzvan Constantin Șerban
- University of Medicine and Pharmacy of Tîrgu Mureș, Tîrgu Mureș, Romania
- Emergency Institute for Cardiovascular Diseases and Transplantation, Tîrgu Mureș, Romania
| | - Ioana Șuș
- University of Medicine and Pharmacy of Tîrgu Mureș, Tîrgu Mureș, Romania
- Emergency Institute for Cardiovascular Diseases and Transplantation, Tîrgu Mureș, Romania
| | - Eva Katalin Lakatos
- University of Medicine and Pharmacy of Tîrgu Mureș, Tîrgu Mureș, Romania
- Emergency Institute for Cardiovascular Diseases and Transplantation, Tîrgu Mureș, Romania
| | - Zoltan Demjen
- Emergency Institute for Cardiovascular Diseases and Transplantation, Tîrgu Mureș, Romania
| | - Alexandru Ceamburu
- Emergency Institute for Cardiovascular Diseases and Transplantation, Tîrgu Mureș, Romania
| | - Paul Ciprian Fișcă
- University of Medicine and Pharmacy of Tîrgu Mureș, Tîrgu Mureș, Romania
- Emergency Institute for Cardiovascular Diseases and Transplantation, Tîrgu Mureș, Romania
| | - Cristina Somkereki
- University of Medicine and Pharmacy of Tîrgu Mureș, Tîrgu Mureș, Romania
- Emergency Institute for Cardiovascular Diseases and Transplantation, Tîrgu Mureș, Romania
| | - Laszlo Hadadi
- University of Medicine and Pharmacy of Tîrgu Mureș, Tîrgu Mureș, Romania
- Emergency Institute for Cardiovascular Diseases and Transplantation, Tîrgu Mureș, Romania
| | - Alina Scridon
- University of Medicine and Pharmacy of Tîrgu Mureș, Tîrgu Mureș, Romania
- Center for Advanced Medical and Pharmaceutical Research, Tîrgu Mureș, Romania
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12
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Parkin L, Quon J, Sharples K, Barson D, Dummer J. Underuse of beta‐blockers by patients with COPD and co‐morbid acute coronary syndrome: A nationwide follow‐up study in New Zealand. Respirology 2019; 25:173-182. [DOI: 10.1111/resp.13662] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 04/16/2019] [Accepted: 06/27/2019] [Indexed: 01/06/2023]
Affiliation(s)
- Lianne Parkin
- Pharmacoepidemiology Research Network Dunedin New Zealand
- Department of Preventive and Social Medicine, Dunedin School of MedicineUniversity of Otago Dunedin New Zealand
| | - Joshua Quon
- Dunedin School of MedicineUniversity of Otago Dunedin New Zealand
| | - Katrina Sharples
- Pharmacoepidemiology Research Network Dunedin New Zealand
- Department of Medicine, Dunedin School of MedicineUniversity of Otago Dunedin New Zealand
- Department of Mathematics and StatisticsUniversity of Otago Dunedin New Zealand
| | - David Barson
- Pharmacoepidemiology Research Network Dunedin New Zealand
- Department of Preventive and Social Medicine, Dunedin School of MedicineUniversity of Otago Dunedin New Zealand
| | - Jack Dummer
- Pharmacoepidemiology Research Network Dunedin New Zealand
- Department of Medicine, Dunedin School of MedicineUniversity of Otago Dunedin New Zealand
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13
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Andell P, James S, Östlund O, Yndigegn T, Sparv D, Pernow J, Jernberg T, Lindahl B, Herlitz J, Erlinge D, Hofmann R. Oxygen therapy in suspected acute myocardial infarction and concurrent normoxemic chronic obstructive pulmonary disease: a prespecified subgroup analysis from the DETO2X-AMI trial. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2019; 9:984-992. [PMID: 31081342 DOI: 10.1177/2048872619848978] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The DETermination of the role of Oxygen in suspected Acute Myocardial Infarction (DETO2X-AMI) trial did not find any benefit of oxygen therapy compared to ambient air in normoxemic patients with suspected acute myocardial infarction. Patients with chronic obstructive pulmonary disease may both benefit and be harmed by supplemental oxygen. Thus we evaluated the effect of routine oxygen therapy compared to ambient air in normoxemic chronic obstructive pulmonary disease patients with suspected acute myocardial infarction. METHODS AND RESULTS A total of 6629 patients with suspected acute myocardial infarction were randomly assigned in the DETO2X-AMI trial to oxygen or ambient air. In the oxygen group (n=3311) and the ambient air group (n=3318), 155 and 141 patients, respectively, had chronic obstructive pulmonary disease (prevalence of 4.5%). Patients with chronic obstructive pulmonary disease were older, had more comorbid conditions and experienced a twofold higher risk of death at one year (chronic obstructive pulmonary disease: 32/296 (10.8%) vs. non-chronic obstructive pulmonary disease: 302/6333 (4.8%)). Oxygen therapy compared to ambient air was not associated with improved outcomes at 365 days (chronic obstructive pulmonary disease: all-cause mortality hazard ratio (HR) 0.99, 95% confidence interval (CI) 0.50-1.99, Pinteraction=0.96); cardiovascular death HR 0.80, 95% CI 0.32-2.04, Pinteraction=0.59); rehospitalisation with acute myocardial infarction or death HR 1.27, 95% CI 0.71-2.28, Pinteraction=0.46); hospitalisation for heart failure or death HR 1.08, 95% CI 0.61-1.91, Pinteraction=0.77]); there were no significant treatment-by-chronic obstructive pulmonary disease interactions. CONCLUSIONS Although chronic obstructive pulmonary disease patients had twice the mortality rate compared to non-chronic obstructive pulmonary disease patients, this prespecified subgroup analysis from the DETO2X-AMI trial on oxygen therapy versus ambient air in normoxemic chronic obstructive pulmonary disease patients with suspected acute myocardial infarction revealed no evidence for benefit of routine oxygen therapy consistent with the main trial's findings. CLINICAL TRIALS REGISTRATION NCT02290080.
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Affiliation(s)
- Pontus Andell
- Unit of Cardiology, Karolinska Institutet, Sweden
- Department of Cardiology, Lund University, Sweden
| | - Stefan James
- Uppsala Clinical Research Center, Uppsala University, Sweden
- Department of Medical Sciences, Uppsala University, Sweden
| | - Ollie Östlund
- Uppsala Clinical Research Center, Uppsala University, Sweden
| | | | - David Sparv
- Department of Cardiology, Lund University, Sweden
| | - John Pernow
- Unit of Cardiology, Karolinska Institutet, Sweden
| | - Tomas Jernberg
- Department of Clinical Sciences, Karolinska Institutet, Sweden
| | - Bertil Lindahl
- Department of Medical Sciences, Uppsala University, Sweden
| | - Johan Herlitz
- Department of Cardiology, Sahlgrenska University Hospital, Sweden
- Department of Health Sciences, University of Borås, Sweden
| | | | - Robin Hofmann
- Department of Clinical Science and Education, Karolinska Institutet, Sweden
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14
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Improving outcomes in chronic obstructive pulmonary disease by taking beta-blockers after acute myocardial infarction: a nationwide observational study. Heart Vessels 2019; 34:1158-1167. [DOI: 10.1007/s00380-019-01341-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 01/11/2019] [Indexed: 10/27/2022]
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15
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Kratzer L, Noakes P, Baumwol J, Wrobel JP. Under-utilisation of β-blockers in patients with acute coronary syndrome and comorbid chronic obstructive pulmonary disease. Intern Med J 2019; 48:931-936. [PMID: 29573074 DOI: 10.1111/imj.13795] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 02/26/2018] [Accepted: 03/05/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND β-blockers are an established mainstay of therapy in acute coronary syndrome (ACS). Despite substantial evidence of their safety and efficacy in chronic obstructive pulmonary disease (COPD) patients, their use in this population remains limited internationally, likely due to fears of inducing bronchospasm. In Australia, little is known about the use of β-blockers in COPD patients hospitalised for ACS. AIM To determine if β-blockers are under-prescribed at discharge for patients with COPD hospitalised for ACS compared to patients without a diagnosis of COPD. METHODS Retrospective analysis of a tertiary metropolitan hospital computer database was undertaken to identify the first 250 patients hospitalised with ACS from 1 March 2015. RESULTS Of the 250 patients analysed, there were five in-hospital fatalities, leaving 245 patients for final analysis. Patients with ACS and COPD received fewer β-blockers at discharge than those with ACS alone (66.7% vs 86.2%, P < 0.05). After controlling for clinically meaningful confounding factors, a logistic regression analysis model determined that, for patients with ACS, the presence of COPD was the only significant predictor of receiving a β-blocker at discharge. CONCLUSION Despite strong evidence supporting the use of β-blockers in COPD patients with ACS, Australian patients with COPD remain under-treated for ACS. More work is needed to alter prescribing attitudes.
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Affiliation(s)
- Logan Kratzer
- School of Medicine, University of Notre Dame, Fremantle, Western Australia, Australia.,Department of Medicine, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Paul Noakes
- School of Medicine, University of Notre Dame, Fremantle, Western Australia, Australia
| | - Jay Baumwol
- Advanced Heart Failure Unit, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Jeremy P Wrobel
- School of Medicine, University of Notre Dame, Fremantle, Western Australia, Australia.,Advanced Lung Disease Unit, Fiona Stanley Hospital, Perth, Western Australia, Australia
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16
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Januszek R, Dziewierz A, Siudak Z, Rakowski T, Dudek D, Bartuś S. Chronic obstructive pulmonary disease and periprocedural complications in patients undergoing percutaneous coronary interventions. PLoS One 2018; 13:e0204257. [PMID: 30273363 PMCID: PMC6166928 DOI: 10.1371/journal.pone.0204257] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 09/04/2018] [Indexed: 11/23/2022] Open
Abstract
Background The relationship between chronic obstructive pulmonary disease (COPD) and periprocedural complications of percutaneous coronary interventions (PCIs) is influenced by several factors. We aimed to investigate the association between COPD, its complication type and rate in patients undergoing PCI. Methods Data were prospectively collected using the Polish Cardiovascular Intervention Society national registry (ORPKI) on all PCIs performed in Poland between January 2015 and December 2016. COPD was present in 5,594 of the 221,187 patients undergoing PCI. We assessed the frequency and predictors of periprocedural complications in PCI. Results Patients with COPD were elder individuals (70.3 ± 9.9 vs. 67 ± 10.8 years; p < 0.05). We noted 145 (2.6%) periprocedural complications in the COPD group and 4,121 (1.9%) in the non-COPD group (p < 0.001). The higher incidence of periprocedural complications in the COPD patients was mainly attributed to cardiac arrest (p = 0.001), myocardial infarctions (p = 0.002) and no-reflows (p < 0.001). COPD was not an independent predictor of all periprocedural complications. On the other hand, COPD was found to be an independent predictor of increased no-reflow risk (odds ratio [OR] 1.447, 95% CI 1.085–1.929; p = 0.01), and at the same time, of decreased risk of periprocedural allergic reactions (OR 0.117, 95% CI 0.016–0.837; p = 0.03). Conclusions In conclusion, periprocedural complications of PCIs are more frequent in patients with COPD. COPD is an independent positive predictor of no-reflow and a negative predictor of periprocedural allergic reactions.
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Affiliation(s)
- Rafał Januszek
- 2 Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - Artur Dziewierz
- 2 Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
- 2 Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Zbigniew Siudak
- Faculty of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland
| | - Tomasz Rakowski
- 2 Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
- 2 Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Dariusz Dudek
- 2 Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
- 2 Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
- Department of Interventional Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Stanisław Bartuś
- 2 Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
- 2 Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
- * E-mail:
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17
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Shukla K, Sonowal H, Saxena A, Ramana KV. Didymin prevents hyperglycemia-induced human umbilical endothelial cells dysfunction and death. Biochem Pharmacol 2018; 152:1-10. [PMID: 29548811 DOI: 10.1016/j.bcp.2018.03.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 03/09/2018] [Indexed: 01/01/2023]
Abstract
Although didymin, a flavonoid-O-glycosides compound naturally found in the citrus fruits, has been reported to be a potent anticancer agent in the prevention of various cancers, its role in the prevention of cardiovascular complications is unclear. Most importantly, its effect in the prevention of endothelial dysfunction, a pathological process involved in the atherogenesis, is unknown. We have examined the efficacy of didymin in preventing the high glucose (HG; 25 mM)-induced human umbilical vein endothelial cells (HUVECs) dysfunction. Our results indicate that incubation of HUVECs with HG resulted in the loss of cell viability, and pre-incubation of didymin prevented it. Further, didymin prevented the HG-induced generation of reactive oxygen species (ROS) as well as lipid peroxidation product, malondialdehyde. Pretreatment of HUVECs with didymin also prevented the HG-induced decrease in eNOS and increase in iNOS expressions. Further, didymin prevented the HG-induced monocytes cell adhesion to endothelial cells, expressions of ICAM-1 and VCAM-1 and activation of NF-κB. Didymin also prevented the release of various inflammatory cytokines and chemokines in HG-treated HUVECs. In conclusion, our results demonstrate that didymin with its anti-oxidative and anti-inflammatory actions prevents hyperglycemia-induced endothelial dysfunction and death. Thus, it could be developed as a potential natural therapeutic agent for the prevention of cardiovascular complications in diabetes.
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Affiliation(s)
- Kirtikar Shukla
- Department of Biochemistry and Molecular Biology, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Himangshu Sonowal
- Department of Biochemistry and Molecular Biology, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Ashish Saxena
- Department of Biochemistry and Molecular Biology, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Kota V Ramana
- Department of Biochemistry and Molecular Biology, University of Texas Medical Branch, Galveston, TX 77555, USA.
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Pinto P, Rothnie KJ, Lui K, Timmis A, Smeeth L, Quint JK. Presentation, management and mortality after a first MI in people with and without asthma: A study using UK MINAP data. Chron Respir Dis 2018; 15:60-70. [PMID: 28393591 PMCID: PMC5802653 DOI: 10.1177/1479972317702140] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 02/10/2017] [Accepted: 02/23/2017] [Indexed: 01/07/2023] Open
Abstract
Asthma has been associated with a higher incidence of myocardial infarction (MI), higher prevalence of MI risk factors and higher burden of cardiovascular diseases. However, detailed associations between the presentation and initial management at the time of MI and post-MI outcomes in people with asthma compared to the general population have not been studied. A total of 300,161 people were identified with a first MI over the period 2003-2013 in the Myocardial Ischaemia National Audit Project database, of whom 8922 (3%) had asthma. Logistic regression was used to compare presentation, in-hospital care, in-hospital and 180-day post-discharge all-cause mortality in people with and without asthma adjusting for demographics and comorbidities, diagnosis on arrival and secondary prevention. People with asthma were more likely to have a delay in their MI diagnosis following an STEMI (ST-elevation myocardial infarction; odds ratio (OR) 1.38, confidence interval CI 1.06-1.79) but not an nSTEMI (non-ST-elevation myocardial infarction; OR 1.04, CI 0.92-1.17) compared to people without asthma and a delay in reperfusion (OR 1.19, CI 1.09-1.30) following an STEMI. They were much less likely to be discharged on a beta blocker following an STEMI or nSTEMI (OR 0.24, CI 0.21-0.28 and OR 0.27, CI 0.24-0.30, respectively). There was no difference in in-hospital or 180-day mortality (OR 0.98, CI 0.59-1.62 and OR 0.99, CI 0.72-1.36) following an STEMI or nSTEMI (OR 0.89, CI 0.47-1.68 and OR 1.05, CI 0.85-1.28). Although people with asthma were more likely to have a delay in diagnosis following an STEMI but not an nSTEMI compared to the general population, were more likely to have a delay in reperfusion therapy and were much less likely to receive beta blockers following an STEMI or nSTEMI, there was no difference in the prescriptions of other secondary prevention medications. None of the differences in presentation or management were associated with an increase in all-cause in-hospital or 180-day mortality in people with asthma compared to the general population.
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Affiliation(s)
- Paulo Pinto
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Kieran J Rothnie
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Kelvin Lui
- Faculty of Life Sciences, University College London, London, UK
| | - Adam Timmis
- Barts NIHR Biomedical Research Unit, Queen Mary University of London, London, UK
| | - Liam Smeeth
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Jennifer K Quint
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
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19
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Tuleta I, Farrag T, Busse L, Pizarro C, Schaefer C, Pingel S, Nickenig G, Skowasch D, Schahab N. High prevalence of COPD in atherosclerosis patients. Int J Chron Obstruct Pulmon Dis 2017; 12:3047-3053. [PMID: 29089753 PMCID: PMC5655122 DOI: 10.2147/copd.s141988] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Atherosclerosis and COPD are both systemic inflammatory diseases that may influence each other. The aim of the present study was to determine the prevalence of COPD in patients with cerebral and/or peripheral artery disease and to assess factors associated with the presence of COPD. Following the diagnosis of cerebral and/or peripheral artery disease by means of duplex sonography, 166 consecutive patients underwent body plethysmography with capillary blood gas analysis. Thereafter, blood tests with determination of different parameters such as lipid profile, inflammatory and coagulation markers were conducted in remaining 136 patients who fulfilled inclusion criteria of the study. Thirty-six out of 136 patients suffered from COPD, mostly in early stages of the disease. Residual volume indicating emphysema was increased (162.9%±55.9% vs 124.5%±37.0%, p<0.05) and diffusion capacity was decreased (55.1%±19.5% vs 75.3%±18.6%, p<0.05) in COPD patients vs non-COPD group. In capillary blood gas analysis, COPD patients had lower partial pressure of oxygen (70.9±11.5 vs 75.2±11.0 mmHg, p<0.05) and higher partial pressure of carbon dioxide (36.8±7.5 vs 34.4±4.4 mmHg, p<0.05) compared with non-COPD individuals. Presence of COPD was associated with predominance of diabetes mellitus, interleukin-8-related systemic neutrophilic inflammation and anemia. In conclusion, COPD is highly prevalent in patients with atherosclerotic artery disease.
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Affiliation(s)
- Izabela Tuleta
- Department of Internal Medicine II – Cardiology, Pulmonology and Angiology, University of Bonn, Bonn, Germany
| | - Tarik Farrag
- Department of Internal Medicine II – Cardiology, Pulmonology and Angiology, University of Bonn, Bonn, Germany
| | - Laura Busse
- Department of Internal Medicine II – Cardiology, Pulmonology and Angiology, University of Bonn, Bonn, Germany
| | - Carmen Pizarro
- Department of Internal Medicine II – Cardiology, Pulmonology and Angiology, University of Bonn, Bonn, Germany
| | - Christian Schaefer
- Department of Internal Medicine II – Cardiology, Pulmonology and Angiology, University of Bonn, Bonn, Germany
| | - Simon Pingel
- Department of Internal Medicine II – Cardiology, Pulmonology and Angiology, University of Bonn, Bonn, Germany
| | - Georg Nickenig
- Department of Internal Medicine II – Cardiology, Pulmonology and Angiology, University of Bonn, Bonn, Germany
| | - Dirk Skowasch
- Department of Internal Medicine II – Cardiology, Pulmonology and Angiology, University of Bonn, Bonn, Germany
| | - Nadjib Schahab
- Department of Internal Medicine II – Cardiology, Pulmonology and Angiology, University of Bonn, Bonn, Germany
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Agarwal M, Agrawal S, Garg L, Garg A, Bhatia N, Kadaria D, Reed G. Effect of Chronic Obstructive Pulmonary Disease on In-Hospital Mortality and Clinical Outcomes After ST-Segment Elevation Myocardial Infarction. Am J Cardiol 2017; 119:1555-1559. [PMID: 28390680 DOI: 10.1016/j.amjcard.2017.02.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 02/06/2017] [Accepted: 02/06/2017] [Indexed: 10/20/2022]
Abstract
There is controversy regarding in-hospital mortality, revascularization, and other adverse outcomes in patients with ST-segment elevation (STEMI) and chronic obstructive pulmonary disease (COPD). We queried the 2003 to 2011 Nationwide Inpatient Sample databases to identify patients aged ≥18 years with a primary diagnosis of STEMI. Univariate and multivariate analyses were performed to evaluate the association of COPD with in-hospital clinical outcomes. Patients with COPD comprised 13.2% of 2,120,005 patients with STEMI. COPD was associated with older age, Medicare insurance, greater co-morbidities, and lower socioeconomic status. Compared with non-COPD patients, patients with COPD had higher inpatient mortality even after adjustment for multiple potential other factors (12.5% vs 8.6%, adjusted odds ratio [AOR] 1.13, 95% CI 1.11 to 1.15, p <0.001). Patients with COPD were more likely to develop new-onset heart failure (AOR 2.01, 95% CI 1.99 to 2.03), cardiogenic shock (AOR 1.24, 95% CI 1.22 to 1.26), and acute respiratory failure (AOR 2.46, 95% CI 2.43 to 2.50) during their hospital stay. Patients with COPD were less likely to undergo diagnostic angiographies and any revascularization procedures. The mean length of stay (6.0 vs 4.6 days; p <0.001) was greater in patients with COPD, as were hospital average hospital charges ($63,956 vs $58,536; p <0.001). In conclusion, among patients with STEMI, COPD is associated with a greater risk of in-hospital mortality, new-onset heart failure, acute respiratory failure, and cardiogenic shock.
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21
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Șerban RC, Hadadi L, Șuș I, Lakatos EK, Demjen Z, Scridon A. Impact of chronic obstructive pulmonary disease on in-hospital morbidity and mortality in patients with ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention. Int J Cardiol 2017; 243:437-442. [PMID: 28506549 DOI: 10.1016/j.ijcard.2017.05.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 05/07/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Patients with chronic obstructive pulmonary disease (COPD) presenting with ST-segment elevation myocardial infarction (STEMI) are less likely to beneficiate of primary percutaneous coronary intervention (pPCI), and have poorer prognosis. We aimed to evaluate the impact of COPD on the in-hospital outcomes of pPCI-treated STEMI patients. METHODS Data were collected from 418 STEMI patients treated by pPCI. Inotropics and diuretics usage, cardiogenic shock, asystole, kidney dysfunction, and left ventricular ejection fraction were used as markers of hemodynamic complications. Atrial and ventricular fibrillation, conduction disorders, and antiarrhythmics usage were used as markers of arrhythmic complications. In-hospital mortality was evaluated. The associations between these parameters and COPD were assessed. RESULTS COPD was present in 7.42% of STEMI patients. COPD patients were older (p=0.02) and less likely to receive beta-blockers (OR 0.29; 95%CI 0.13-0.64; p<0.01). They had higher Killip class on admission (p<0.001), received more often inotropics (p<0.001) and diuretics (p<0.01), and presented more often atrial (p=0.01) and ventricular fibrillation (p=0.02). Unadjusted in-hospital mortality was higher in COPD patients (OR 4.18, 95%CI 1.55-11.30, p<0.01). After adjustment for potentially confounding factors except beta-blockers, COPD remained an independent predictor of in-hospital mortality (p=0.02). After further adjustment with beta-blocker therapy, no excess mortality was noted in COPD patients. CONCLUSIONS Despite being treated by pPCI, COPD patients with STEMI are more likely to develop hemodynamic and arrhythmic complications, and have higher in-hospital mortality. This appears to be due to lower beta-blockers usage in COPD patients. Increasing beta-blockers usage in COPD patients with STEMI may improve survival.
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Affiliation(s)
- Răzvan Constantin Șerban
- University of Medicine and Pharmacy of Tîrgu Mureș, 540139 Tîrgu Mureș, Romania; Emergency Institute for Cardiovascular Diseases and Transplantation Tîrgu Mureș, 540136 Tîrgu Mureș, Romania
| | - Laszlo Hadadi
- University of Medicine and Pharmacy of Tîrgu Mureș, 540139 Tîrgu Mureș, Romania; Emergency Institute for Cardiovascular Diseases and Transplantation Tîrgu Mureș, 540136 Tîrgu Mureș, Romania
| | - Ioana Șuș
- University of Medicine and Pharmacy of Tîrgu Mureș, 540139 Tîrgu Mureș, Romania; Emergency Institute for Cardiovascular Diseases and Transplantation Tîrgu Mureș, 540136 Tîrgu Mureș, Romania
| | - Eva Katalin Lakatos
- University of Medicine and Pharmacy of Tîrgu Mureș, 540139 Tîrgu Mureș, Romania; Emergency Institute for Cardiovascular Diseases and Transplantation Tîrgu Mureș, 540136 Tîrgu Mureș, Romania
| | - Zoltan Demjen
- Emergency Institute for Cardiovascular Diseases and Transplantation Tîrgu Mureș, 540136 Tîrgu Mureș, Romania
| | - Alina Scridon
- University of Medicine and Pharmacy of Tîrgu Mureș, 540139 Tîrgu Mureș, Romania.
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Su TH, Chang SH, Chen PC, Chan YL. Temporal Trends in Treatment and Outcomes of Acute Myocardial Infarction in Patients With Chronic Obstructive Pulmonary Disease: A Nationwide Population-Based Observational Study. J Am Heart Assoc 2017; 6:e004525. [PMID: 28298371 PMCID: PMC5524002 DOI: 10.1161/jaha.116.004525] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 02/15/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Acute myocardial infarction is a major cause of hospitalization and death in patients with chronic obstructive pulmonary disease (COPD); however, temporal trends in the management and clinical outcomes of these patients remain unclear. METHODS AND RESULTS We conducted an observational study by using a representative sample of 1 million beneficiaries from the Taiwan National Health Insurance Research Database. Comorbidities, in-hospital treatment, and outcomes were compared for patients with acute myocardial infarction with and without COPD between 2004 and 2013. Temporal trends in treatment and outcomes were analyzed. We included 6770 patients admitted to hospitals with acute myocardial infarction diagnoses, of whom 1921 (28.3%) had COPD. Fewer patients with COPD received β-blockers (adjusted odds ratio 0.66, 95% CI 0.59-0.74), angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (adjusted odds ratio 0.83, 95% CI 0.73-0.93), statins, anticoagulants, dual antiplatelets, and coronary interventions. These patients had higher mortality (in hospital: adjusted hazard ratio 1.25 [95% CI 1.11-1.41]; 1 year: adjusted hazard ratio 1.20 [95% CI 1.09-1.32]) and respiratory failure risk during admission. Temporal trends showed little improvement in mortality in patients with COPD over 10 years. Multivariable logistic regression indicated that dual antiplatelets, β-blockers, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, statins, coronary angiography, and coronary artery bypass grafting surgery were significantly correlated with improved mortality in patients with COPD. CONCLUSIONS In Taiwan, a lower proportion of patients with COPD received evidence-based therapies for acute myocardial infarction than did patients without COPD, and their clinical outcomes were inferior. Limited improvement in mortality was observed over the preceding 10 years and is attributable to the underuse of evidence-based treatments.
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Affiliation(s)
- Tse-Hsuan Su
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Shang-Hung Chang
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Pei-Chun Chen
- Department of Public Health, China Medical University, Taichung, Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Yi-Ling Chan
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
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23
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Corlateanu A, Covantev S, Mathioudakis AG, Botnaru V, Siafakas N. Prevalence and burden of comorbidities in Chronic Obstructive Pulmonary Disease. Respir Investig 2016; 54:387-396. [PMID: 27886849 DOI: 10.1016/j.resinv.2016.07.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 07/01/2016] [Indexed: 02/08/2023]
Abstract
The classical definition of Chronic Obstructive Pulmonary Disease (COPD) as a lung condition characterized by irreversible airway obstruction is outdated. The systemic involvement in patients with COPD, as well as the interactions between COPD and its comorbidities, justify the description of chronic systemic inflammatory syndrome. The pathogenesis of COPD is closely linked with aging, as well as with cardiovascular, endocrine, musculoskeletal, renal, and gastrointestinal pathologies, decreasing the quality of life of patients with COPD and, furthermore, complicating the management of the disease. The most frequently described comorbidities include skeletal muscle wasting, cachexia (loss of fat-free mass), lung cancer (small cell or non-small cell), pulmonary hypertension, ischemic heart disease, hyperlipidemia, congestive heart failure, normocytic anemia, diabetes, metabolic syndrome, osteoporosis, obstructive sleep apnea, depression, and arthritis. These complex interactions are based on chronic low-grade systemic inflammation, chronic hypoxia, and multiple common predisposing factors, and are currently under intense research. This review article is an overview of the comorbidities of COPD, as well as their interaction and influence on mutual disease progression, prognosis, and quality of life.
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Affiliation(s)
- Alexandru Corlateanu
- Department of Respiratory Medicine, State University of Medicine and Pharmacy "Nicolae Testemitanu", Stefan cel Mare Street 165, 2004 Chisinau, Republic of Moldova.
| | - Serghei Covantev
- Department of Respiratory Medicine, State University of Medicine and Pharmacy "Nicolae Testemitanu", Stefan cel Mare Street 165, 2004 Chisinau, Republic of Moldova.
| | - Alexander G Mathioudakis
- Chest Centre, Aintree University Hospitals NHS Foundation Trust, Langmoor Lane, Liverpool, Merseyside L9 7AL, United Kingdom.
| | - Victor Botnaru
- Department of Respiratory Medicine, State University of Medicine and Pharmacy "Nicolae Testemitanu", Stefan cel Mare Street 165, 2004 Chisinau, Republic of Moldova.
| | - Nikolaos Siafakas
- University General Hospital, Department of Thoracic Medicine, Stavrakia, 71110 Heraklion, Crete, Greece.
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24
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Timóteo AT. Is there still a place for improvement in acute coronary syndrome risk stratification?: Table 1. BRITISH HEART JOURNAL 2016; 102:1423-4. [DOI: 10.1136/heartjnl-2016-309860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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25
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Franssen FME, Soriano JB, Roche N, Bloomfield PH, Brusselle G, Fabbri LM, García-Rio F, Kearney MT, Kwon N, Lundbäck B, Rabe KF, Raillard A, Muellerova H, Cockcroft JR. Lung Function Abnormalities in Smokers with Ischemic Heart Disease. Am J Respir Crit Care Med 2016; 194:568-76. [DOI: 10.1164/rccm.201512-2480oc] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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26
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Khafaji HAR, Sulaiman K, Singh R, Alhabib KF, Asaad N, Alsheikh-Ali A, Al-Jarallah M, Bulbanat B, Almahmeed W, Ridha M, Bazargani N, Amin H, Al-Motarreb A, Faleh HA, Elasfar A, Panduranga P, Suwaidi JA. Chronic obstructive airway disease among patients hospitalized with acute heart failure; clinical characteristics, precipitating factors, management and outcome: Observational report from the Middle East. ACTA ACUST UNITED AC 2016; 17:55-66. [DOI: 10.1080/17482941.2016.1203438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Hadi A. R. Khafaji
- Department of Cardiology, Saint Michael's Hospital, Toronto University, Toronto, Canada
| | - Kadhim Sulaiman
- Biostatistics Section, Department of Cardiology, Royal Hospital, Muscat, Oman
| | - Rajvir Singh
- Cardiovascular Research, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Khalid F. Alhabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia
| | - Nidal Asaad
- Adult Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Alawi Alsheikh-Ali
- Department of Cardiology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | | | - Bassam Bulbanat
- Department of Cardiology, Sabah Al-Ahmed Cardiac Center, Kuwait City, Kuwait
| | - Wael Almahmeed
- Adult Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Mustafa Ridha
- Department of Cardiology, Adan Hospital, Hadiya, Kuwait
| | - Nooshin Bazargani
- Department of Cardiology, Dubai Hospital, Dubai, United Arab Emirates
| | - Haitham Amin
- Department of Cardiology, Mohammed Bin Khalifa Cardiac Center, Manamah, Bahrain
| | - Ahmed Al-Motarreb
- Department of Cardiology, Faculty of Medicine, Sana'a University, Sana'a, Yemen
| | - Husam Al Faleh
- Department of Cardiology and Cardiovascular Surgery, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Abdelfatah Elasfar
- Department of Cardiology, Prince Salman Heart Center, King Fahad Medical City, Saudi Arabia
| | | | - Jassim Al Suwaidi
- Cardiovascular Research, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
- Adult Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
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27
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Rothnie KJ, Quint JK. Chronic obstructive pulmonary disease and acute myocardial infarction: effects on presentation, management, and outcomes. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2016; 2:81-90. [PMID: 29474627 PMCID: PMC5862020 DOI: 10.1093/ehjqcco/qcw005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Indexed: 01/09/2023]
Abstract
Cardiovascular disease is a common cause of death in patients with chronic obstructive pulmonary disease (COPD) and is a key target for improving outcomes. However, there are concerns that patients with COPD may not have enjoyed the same mortality reductions from acute myocardial infarction (AMI) in recent decades as the general population. This has raised questions about differences in presentation, management and outcomes in COPD patients compared to non-COPD patients. The evidence points to an increased risk of death after AMI in patients with COPD, but it is unclear to what extent this is attributable to COPD itself or to modifiable factors including under-treatment with guideline-recommended interventions and drugs. We review the evidence for differences between COPD and non-COPD patients in terms of the presentation of AMI, its treatment, and outcomes both in hospital and in the longer term.
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Affiliation(s)
- Kieran J. Rothnie
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London, Emmanuel Kaye Building, London SW3 6LR, UK
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Jennifer K. Quint
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London, Emmanuel Kaye Building, London SW3 6LR, UK
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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28
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Polikutina OM, Slepynina YS, Bazdyrev ED, Karetnikova VN, Barbarach OL. [Impact of chronic obstructive pulmonary disease on one-year prognosis in patients with ST-segment elevation myocardial infarction]. TERAPEVT ARKH 2015; 87:52-57. [PMID: 26591553 DOI: 10.17116/terarkh201587952-57] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To assess the role of chronic obstructive pulmonary disease (COPD) in the development of unfavorable outcomes of long-term (one-year) prognosis of ST-elevation myocardial infarction (STEMI). SUBJECTS AND METHODS A total of 529 patients diagnosed with STEMI and no age limits were examined. Group 1 included 65 (12.3%) patients with previously diagnosed COPD; Group 2 consisted of 464 (87.7%) patients without COPD. One-year prognosis was studied in 384 (81.5%) patients. The investigators evaluated the following endpoints: evolving recurrent myocardial infarction (MI), progressive angina pectoris, decompensated chronic heart failure (CHF), repeat percutaneous coronary interventions, stroke, and death. RESULTS The prevalence of COPD was 12.3% in the patients with STEM]. Unfavorable one-year prognosis was significantly more often registered in the comorbidity group regardless of age, gender, and smoking status. COPD increased the risk of combined endpoints by 1.9 times within a year after MI and that of decompensated CHD by 2.6 times during a year after STEM. CONCLUSION COPD may be an independent risk factor for unfavorable outcomes during a year after MI.
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Affiliation(s)
- O M Polikutina
- Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | - Yu S Slepynina
- Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | - E D Bazdyrev
- Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | - V N Karetnikova
- Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | - O L Barbarach
- Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
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29
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Andell P, James SK, Cannon CP, Cyr DD, Himmelmann A, Husted S, Keltai M, Koul S, Santoso A, Steg PG, Storey RF, Wallentin L, Erlinge D. Ticagrelor Versus Clopidogrel in Patients With Acute Coronary Syndromes and Chronic Obstructive Pulmonary Disease: An Analysis From the Platelet Inhibition and Patient Outcomes (PLATO) Trial. J Am Heart Assoc 2015; 4:e002490. [PMID: 26452988 PMCID: PMC4845124 DOI: 10.1161/jaha.115.002490] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with chronic obstructive pulmonary disease (COPD) experiencing acute coronary syndromes (ACS) are at high risk for clinical events. In the Platelet Inhibition and Patient Outcomes (PLATO) trial, ticagrelor versus clopidogrel reduced the primary endpoint of death from vascular causes, myocardial infarction, or stroke after ACS, but increased the incidence of dyspnea, which may lead clinicians to withhold ticagrelor from COPD patients. METHODS AND RESULTS In 18 624 patients with ACS randomized to treatment with ticagrelor or clopidogrel, history of COPD was recorded in 1085 (5.8%). At 1 year, the primary endpoint occurred in 17.7% of patients with COPD versus 10.4% in those without COPD (P<0.001). The 1-year event rate for the primary endpoint in COPD patients treated with ticagrelor versus clopidogrel was 14.8% versus 20.6% (hazard ratio [HR]=0.72; 95% confidence interval [CI]: 0.54 to 0.97), for death from any cause 8.4% versus 12.4% (HR=0.70; 95% CI: 0.47 to 1.04), and for PLATO-defined major bleeding rates at 1 year 14.6% versus 16.6% (HR=0.85; 95% CI: 0.61 to 1.17). Dyspnea occurred more frequently with ticagrelor (26.1% vs. 16.3%; HR=1.71; 95% CI: 1.28 to 2.30). There was no differential increase in the relative risk of dyspnea compared to non-COPD patients (HR=1.85). No COPD status-by-treatment interactions were found, showing consistency with the main trial results. CONCLUSIONS In this post-hoc analysis, COPD patients experienced high rates of ischemic events. Ticagrelor versus clopidogrel reduced and substantially decreased the absolute risk of ischemic events (5.8%) in COPD patients, without increasing overall major bleeding events. The benefit-risk profile supports the use of ticagrelor in patients with ACS and concomitant COPD. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00391872.
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Affiliation(s)
- Pontus Andell
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden (P.A., S.K., D.E.)
| | - Stefan K James
- Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden (S.K.J., L.W.)
| | - Christopher P Cannon
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (C.P.C.) Harvard Clinical Research Institute, Boston, MA (C.P.C.)
| | - Derek D Cyr
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (D.D.C.)
| | | | - Steen Husted
- Medical Department, Hospital Unit West, Herning/Holstebro, Denmark (S.H.)
| | - Matyas Keltai
- Hungarian Institute of Cardiology, Semmelweis University, Budapest, Hungary (M.K.)
| | - Sasha Koul
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden (P.A., S.K., D.E.)
| | - Anwar Santoso
- Department of Cardiology, Vascular Medicine, Faculty of Medicine, Harapan Kita Hospital, National Cardiovascular Center, University of Indonesia, Jakarta, Indonesia (A.S.)
| | - Ph Gabriel Steg
- INSERM-Unité 1148, Paris, France (P.G.S.) Département Hospitalo-Universitaire FIRE, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Paris, France (P.G.S.) Sorbonne-Paris Cité, Université Paris-Diderot, Paris, France (P.G.S.) NHLI Imperial College, ICMS, Royal Brompton Hospital, London, UK (P.G.S.)
| | - Robert F Storey
- Department of Cardiovascular Science, University of Sheffield Sheffield, UK (R.F.S.)
| | - Lars Wallentin
- Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden (S.K.J., L.W.)
| | - David Erlinge
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden (P.A., S.K., D.E.)
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30
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Zubaid M, Ahmed Albinali H, Almahmeed W. The Gulf Heart Association: a professional association supporting research and collaboration in the Middle East. Eur Heart J Suppl 2015. [DOI: 10.1093/eurheartj/suv044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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31
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Rothnie KJ, Yan R, Smeeth L, Quint JK. Risk of myocardial infarction (MI) and death following MI in people with chronic obstructive pulmonary disease (COPD): a systematic review and meta-analysis. BMJ Open 2015; 5:e007824. [PMID: 26362660 PMCID: PMC4567661 DOI: 10.1136/bmjopen-2015-007824] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Cardiovascular disease is an important comorbidity in patients with chronic obstructive pulmonary disease (COPD). We aimed to systematically review the evidence for: (1) risk of myocardial infarction (MI) in people with COPD; (2) risk of MI associated with acute exacerbation of COPD (AECOPD); (3) risk of death after MI in people with COPD. DESIGN Systematic review and meta-analysis. METHODS MEDLINE, EMBASE and SCI were searched up to January 2015. Two reviewers screened abstracts and full text records, extracted data and assessed studies for risk of bias. We used the generic inverse variance method to pool effect estimates, where possible. Evidence was synthesised in a narrative review where meta-analysis was not possible. RESULTS Searches yielded 8362 records, and 24 observational studies were included. Meta-analysis showed increased risk of MI associated with COPD (HR 1.72, 95% CI 1.22 to 2.42) for cohort analyses, but not in case-control studies: OR 1.18 (0.80 to 1.76). Both included studies that investigated the risk of MI associated with AECOPD found an increased risk of MI after AECOPD (incidence rate ratios, IRR 2.27, 1.10 to 4.70, and IRR 13.04, 1.71 to 99.7). Meta-analysis showed weak evidence for increased risk of death for patients with COPD in hospital after MI (OR 1.13, 0.97 to 1.31). However, meta-analysis showed an increased risk of death after MI for patients with COPD during follow-up (HR 1.26, 1.13 to 1.40). CONCLUSIONS There is good evidence that COPD is associated with increased risk of MI; however, it is unclear to what extent this association is due to smoking status. There is some evidence that the risk of MI is higher during AECOPD than stable periods. There is poor evidence that COPD is associated with increased in hospital mortality after an MI, and good evidence that longer term mortality is higher for patients with COPD after an MI.
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Affiliation(s)
- Kieran J Rothnie
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London, London, UK
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Ruoling Yan
- Medical School, Faculty of Medical Sciences, University College London, London, UK
| | - Liam Smeeth
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Jennifer K Quint
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London, London, UK
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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32
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Almagro P, Lapuente A, Pareja J, Yun S, Garcia ME, Padilla F, Heredia JLI, De la Sierra A, Soriano JB. Underdiagnosis and prognosis of chronic obstructive pulmonary disease after percutaneous coronary intervention: a prospective study. Int J Chron Obstruct Pulmon Dis 2015. [PMID: 26213464 PMCID: PMC4509531 DOI: 10.2147/copd.s84482] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Retrospective studies based on clinical data and without spirometric confirmation suggest a poorer prognosis of patients with ischemic heart disease (IHD) and chronic obstructive pulmonary disease (COPD) following percutaneous coronary intervention (PCI). The impact of undiagnosed COPD in these patients is unknown. We aimed to evaluate the prognostic impact of COPD - previously or newly diagnosed - in patients with IHD treated with PCI. METHODS Patients with IHD confirmed by PCI were consecutively included. After PCI they underwent forced spirometry and evaluation for cardiovascular risk factors. All-cause mortality, new cardiovascular events, and their combined endpoint were analyzed. RESULTS A total of 133 patients (78%) male, with a mean (SD) age of 63 (10.12) years were included. Of these, 33 (24.8%) met the spirometric criteria for COPD, of whom 81.8% were undiagnosed. IHD patients with COPD were older, had more coronary vessels affected, and a greater history of previous myocardial infarction. Median follow-up was 934 days (interquartile range [25%-75%]: 546-1,160). COPD patients had greater mortality (P=0.008; hazard ratio [HR]: 8.85; 95% confidence interval [CI]: 1.76-44.47) and number of cardiovascular events (P=0.024; HR: 1.87; 95% CI: 1.04-3.33), even those without a previous diagnosis of COPD (P=0.01; HR: 1.78; 95% CI: 1.12-2.83). These differences remained after adjustment for sex, age, number of coronary vessels affected, and previous myocardial infarction (P=0.025; HR: 1.83; 95% CI: 1.08-3.1). CONCLUSION Prevalence and underdiagnosis of COPD in patients with IHD who undergo PCI are both high. These patients have an independent greater mortality and a higher number of cardiovascular events during follow-up.
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Affiliation(s)
- Pere Almagro
- Department of Internal Medicine, Mutua de Terrassa University Hospital, Terrassa, Spain
| | - Anna Lapuente
- Pneumology Service, Mutua de Terrassa University Hospital, Terrassa, Spain
| | - Julia Pareja
- Department of Internal Medicine, Mutua de Terrassa University Hospital, Terrassa, Spain
| | - Sergi Yun
- Department of Internal Medicine, Mutua de Terrassa University Hospital, Terrassa, Spain
| | | | - Ferrán Padilla
- Cardiology Service, Mutua de Terrassa University Hospital, Terrassa, Spain
| | - Josep L I Heredia
- Pneumology Service, Mutua de Terrassa University Hospital, Terrassa, Spain
| | - Alex De la Sierra
- Department of Internal Medicine, Mutua de Terrassa University Hospital, Terrassa, Spain
| | - Joan B Soriano
- Instituto de Investigación Sanitaria Princesa (IP), Universidad Autónoma de Madrid, Madrid, Spain
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Andell P, Erlinge D, Smith JG, Sundström J, Lindahl B, James S, Koul S. β-blocker use and mortality in COPD patients after myocardial infarction: a Swedish nationwide observational study. J Am Heart Assoc 2015; 4:e001611. [PMID: 25854796 PMCID: PMC4579937 DOI: 10.1161/jaha.114.001611] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 03/05/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients with myocardial infarction (MI) and concomitant chronic obstructive pulmonary disease (COPD) constitute a high-risk group with increased mortality. β-Blocker therapy has been shown to reduce mortality, prevent arrhythmias, and delay heart failure development after an MI in broad populations. However, the effect of β-blockers in COPD patients is less well established and they may also be less treated due to fear of adverse reactions. We investigated β-blocker prescription at discharge in patients with COPD after MI. METHODS AND RESULTS Patients hospitalized for MI between 2005 and 2010 were identified from the nationwide Swedish SWEDEHEART registry. Patients with COPD who were alive and discharged after an MI were selected as the study population. In this cohort, patients who were discharged with β-blockers were compared to patients not discharged with β-blockers. The primary end point was all-cause mortality. A total of 4858 patients were included, of which 4086 (84.1%) were discharged with a β-blocker while 772 (15.9%) were not. After adjusting for potential confounders including baseline characteristics, comorbidities, and in-hospital characteristics, patients discharged with a β-blocker had lower all-cause mortality (hazard ratio 0.87, 95% CI 0.78 to 0.98) during the total follow-up time (maximum 7.2 years). In the subgroup of patients with a history of heart failure, the corresponding hazard ratio was 0.77 (95% CI 0.63 to 0.95). CONCLUSIONS Patients with COPD discharged with β-blockers after an MI had a lower all-cause mortality compared to patients not prescribed β-blockers. The results indicate that MI patients with COPD may benefit from β-blockers.
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Affiliation(s)
- Pontus Andell
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden (P.A., D.E., G.S., S.K.)
| | - David Erlinge
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden (P.A., D.E., G.S., S.K.)
| | - J. Gustav Smith
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden (P.A., D.E., G.S., S.K.)
| | - Johan Sundström
- Department of Medical Sciences and Cardiology, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden (J.S., B.L., S.J.)
| | - Bertil Lindahl
- Department of Medical Sciences and Cardiology, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden (J.S., B.L., S.J.)
| | - Stefan James
- Department of Medical Sciences and Cardiology, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden (J.S., B.L., S.J.)
| | - Sasha Koul
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden (P.A., D.E., G.S., S.K.)
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Rothnie KJ, Smeeth L, Herrett E, Pearce N, Hemingway H, Wedzicha J, Timmis A, Quint JK. Closing the mortality gap after a myocardial infarction in people with and without chronic obstructive pulmonary disease. Heart 2015; 101:1103-10. [PMID: 25765553 PMCID: PMC4516011 DOI: 10.1136/heartjnl-2014-307251] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 02/13/2015] [Indexed: 11/06/2022] Open
Abstract
Objective Patients with chronic obstructive pulmonary disease (COPD) have increased mortality following myocardial infarction (MI) compared with patients without COPD. We investigated the extent to which differences in recognition and management after MI could explain the mortality difference. Methods 300 161 patients with a first MI between 2003 and 2013 were identified in the UK Myocardial Ischaemia National Audit Project database. Logistic regression was used to compare mortality in hospital and at 180 days postdischarge between patients with and without COPD. Variables relating to inhospital factors (delay in diagnosis, use of reperfusion and time to reperfusion/use of angiography) and use of secondary prevention were sequentially added to models. Results Mortality was higher for patients with COPD both inhospital (4.6% vs 3.2%) and at 180 days (12.8% vs 7.7%). After adjusting for inhospital factors, the effect of COPD on inhospital mortality after MI was reduced for both ST-elevation myocardial infarctions (STEMIs) and non-STEMIs (STEMIs OR 1.24 (95% CI 1.10 to 1.41) to 1.13 (95% CI 0.99 to 1.29); non-STEMIs OR 1.34 (95% CI 1.24 to 1.45) to 1.16 (95% CI 1.07 to 1.26)). Adjusting for inhospital factors reduced the effect of COPD on mortality after non-STEMI at 180 days (OR 1.56 (95% CI 1.47 to 1.65) to 1.37 (95% CI 1.31 to 1.44)). Adjusting for use of secondary prevention also reduced the effect of COPD on mortality at 180 days for STEMIs and non-STEMIs (STEMIs OR 1.45 (95% CI 1.31 to 1.61) to 1.25 (95% CI 1.11 to 1.41); non-STEMIs OR 1.37 (95% CI 1.31 to 1.44) to 1.26 (95% CI 1.17 to 1.35). Conclusions Delayed diagnosis, timing and use of reperfusion of a STEMI, use of angiography after a non-STEMI and use of secondary prevention medicines are all potential explanations for the mortality gap after MI in people with COPD.
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Affiliation(s)
- Kieran J Rothnie
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Liam Smeeth
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK Farr Institute of Health Informatics Research, London, UK
| | - Emily Herrett
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Neil Pearce
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Harry Hemingway
- Farr Institute of Health Informatics Research, London, UK Department of Epidemiology and Public Health, University College London, London, UK
| | - Jadwiga Wedzicha
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Adam Timmis
- Farr Institute of Health Informatics Research, London, UK Barts NIHR Biomedical Research Unit, Queen Mary University of London, London, UK
| | - Jennifer K Quint
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Mooe T, Stenfors N. The Prevalence of COPD in Individuals with Acute Coronary Syndrome: A Spirometry-Based Screening Study. COPD 2014; 12:453-61. [DOI: 10.3109/15412555.2014.974742] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Romano ER, Liguori IM, Farran JA, Egito RMPD, Romano MLP, Werneck VA, Barbosa MAO, Egito ESTD, Cavalcanti AB, Piegas LS. Prognostic score for acute coronary syndrome in a private terciary hospital. Arq Bras Cardiol 2014; 102:226-36. [PMID: 24714793 PMCID: PMC3987312 DOI: 10.5935/abc.20140012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 10/09/2013] [Indexed: 11/20/2022] Open
Abstract
Background Available predictive models for acute coronary syndromes (ACS) have limitations as
they have been elaborated some years ago or limitations with applicability. Objectives To develop scores for predicting adverse events in 30 days and 6 months in
ST-segment elevation and non-ST-segment elevation ACS patients admitted to private
tertiary hospital. Methods Prospective cohort of ACS patients admitted between August, 2009 and June, 2012.
Our primary composite outcome for both the 30-day and 6-month models was death
from any cause, myocardial infarction or re-infarction, cerebrovascular accident
(CVA), cardiac arrest and major bleeding. Predicting variables were selected for
clinical, laboratory, electrocardiographic and therapeutic data. The final model
was obtained with multiple logistic regression and submitted to internal
validation with bootstrap analysis. Results We considered 760 patients for the development sample, of which 132 had ST-segment
elevation ACS and 628 non-ST-segment elevation ACS. The mean age was 63.2 ±
11.7 years, and 583 were men (76.7%). The final model to predict 30-day events is
comprised by five independent variables: age ≥ 70 years, history of cancer,
left ventricular ejection fraction (LVEF) < 40%, troponin I > 12.4 ng /ml
and chemical thrombolysis. In the internal validation, the model showed good
discrimination with C-statistic of 0.71. The predictors in the 6-month event final
model are: history of cancer, LVEF < 40%, chemical thrombolysis, troponin I
>14.3 ng/ml, serum creatinine>1.2 mg/dl, history of chronic obstructive
pulmonary disease and hemoglobin < 13.5 g/dl. In the internal validation, the
model had good performance with C-statistic of 0.69. Conclusion We have developed easy to apply scores for predicting 30-day and 6-month adverse
events in patients with ST-elevation and non-ST-elevation ACS.
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Andell P, Koul S, Martinsson A, Sundström J, Jernberg T, Smith JG, James S, Lindahl B, Erlinge D. Impact of chronic obstructive pulmonary disease on morbidity and mortality after myocardial infarction. Open Heart 2014; 1:e000002. [PMID: 25332773 PMCID: PMC4189340 DOI: 10.1136/openhrt-2013-000002] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 11/26/2013] [Accepted: 11/27/2013] [Indexed: 11/24/2022] Open
Abstract
AIM To gain a better understanding of the impact of chronic obstructive pulmonary disease (COPD) on long-term mortality in patients with myocardial infarction (MI) and identify areas where the clinical care for these patients may be improved. METHODS Patients hospitalised for MI between 2005 and 2010 were identified from the nationwide Swedish SWEDEHEART registry. Patients with MI and a prior COPD hospital discharge diagnosis were compared to patients with MI without a prior COPD hospital discharge diagnosis for the primary endpoint of all-cause mortality at 1 year after MI. Secondary endpoints included rates of reinfarction, new-onset stroke, new-onset bleeding and new-onset heart failure at 1 year. RESULTS A total of 81 191 MI patients were included, of which 4867 (6%) had a COPD hospital discharge diagnosis at baseline. Patients with COPD showed a significantly higher unadjusted 1-year mortality (24.6 vs 13.8%) as well as a higher rate of reinfarction, new-onset bleeding and new-onset heart failure post-MI. After adjustment for potential confounders, including comorbidities and treatment, the patients with COPD still showed a significantly higher 1-year mortality (HR 1.14, 95% CI 1.07 to 1.21) as well as a higher rate of new-onset heart failure (HR 1.35, 95% CI 1.24 to 1.47), whereas no significant association between COPD and myocardial reinfarction or new-onset bleeding remained. CONCLUSIONS In this nationwide contemporary study, patients with COPD frequently had an atypical presentation, less often underwent revascularisation and less often received guideline-recommended secondary preventive medications of established benefit. Prior COPD was associated with a higher 1-year mortality and a higher risk of subsequent new-onset heart failure after MI. The association seems to be mainly explained by differences in background characteristics, comorbidities and treatment, although a minor part might be explained by COPD in itself. Improved in-hospital MI treatment and post-MI secondary prevention according to the guidelines may lower the mortality in this high-risk population.
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Affiliation(s)
- Pontus Andell
- Department of Cardiology, Lund University, Lund, Sweden
| | - Sasha Koul
- Department of Cardiology, Lund University, Lund, Sweden
| | | | - Johan Sundström
- Department of Medical Sciences and Cardiology, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Tomas Jernberg
- Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | | | - Stefan James
- Department of Medical Sciences and Cardiology, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Bertil Lindahl
- Department of Medical Sciences and Cardiology, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - David Erlinge
- Department of Cardiology, Lund University, Lund, Sweden
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Bhatt SP, Dransfield MT. Chronic obstructive pulmonary disease and cardiovascular disease. Transl Res 2013; 162:237-51. [PMID: 23727296 DOI: 10.1016/j.trsl.2013.05.001] [Citation(s) in RCA: 145] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Revised: 04/30/2013] [Accepted: 05/07/2013] [Indexed: 11/18/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is an inflammatory disease of the lung associated with progressive airflow limitation and punctuated by episodes of acute exacerbation. There is growing recognition that the inflammatory state associated with COPD is not confined to the lungs but also involves the systemic circulation and can impact nonpulmonary organs. Epidemiologic and mechanistic studies indicate that COPD is associated with a high frequency of coronary artery disease, congestive heart failure and cardiac arrhythmias, independent of shared risk factors. Possible pathways include complex interrelationships between chronic low-grade systemic inflammation and oxidative stress as well as shared risk factors such as age, cigarette smoking, and environmental pollutants. In this review, we provide an overview of the epidemiologic data linking COPD with cardiovascular disease, comment on the interrelationships among COPD, inflammation, and cardiovascular disease, and highlight diagnostic and therapeutic challenges.
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Affiliation(s)
- Surya P Bhatt
- UAB Lung Health Center, University of Alabama at Birmingham, Birmingham, Ala
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Nozzoli C, Beghè B, Boschetto P, Fabbri LM. Identifying and Treating COPD in Cardiac Patients. Chest 2013; 144:723-726. [DOI: 10.1378/chest.13-0915] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
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Enriquez JR, de Lemos JA, Parikh SV, Peng SA, Spertus JA, Holper EM, Roe MT, Rohatgi A, Das SR. Association of chronic lung disease with treatments and outcomes patients with acute myocardial infarction. Am Heart J 2013; 165:43-9. [PMID: 23237132 DOI: 10.1016/j.ahj.2012.09.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 09/19/2012] [Indexed: 12/22/2022]
Abstract
BACKGROUND Although chronic lung disease (CLD) is common among patients with myocardial infarction (MI), little is known about the influence of CLD on patient management and outcomes following MI. METHODS Using the National Cardiovascular Data Registry's ACTION Registry-GWTG, demographics, clinical characteristics, treatments, processes of care, and in-hospital adverse events after acute MI were compared between patients with (n = 22,624) and without (n = 136,266) CLD. Multivariable adjustment was performed to determine the independent association of CLD with treatments and adverse events. RESULTS CLD (17.0% of non-ST-elevation MI [NSTEMI] and 10.1% of ST-elevation MI [STEMI] patients) was associated with older age, female sex, and a greater burden of comorbidities. Among NSTEMI patients, those with CLD were less likely to undergo cardiac catheterization, percutaneous coronary intervention, and coronary artery bypass graft compared to those without; in contrast, no differences were seen in invasive therapies for STEMI patients with or without CLD. Multivariable-adjusted risk of major bleeding was significantly increased in CLD patients with NSTEMI (13.0% vs 8.1%, OR(adj) = 1.27, 95% CI = 1.20-1.34, P < .001) and STEMI (16.0% vs 10.5%, OR(adj) = 1.19, 95% CI = 1.10-1.29, P < .001). In NSTEMI, CLD was associated with a higher risk of inhospital mortality (OR(adj) = 1.21, 95% CI = 1.11-1.33); in STEMI no association between CLD and mortality was seen (OR(adj) = 1.05, 95% CI = 0.95-1.17). CONCLUSIONS CLD is common among patients with MI and is independently associated with an increased risk for major bleeding. In NSTEMI, CLD is also associated with receiving less revascularization and with increased in-hospital mortality. Special attention should be given to this high-risk subgroup for the prevention and management of complications after MI.
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Park TY, Kim KH, Koo HK, Lee JY, Lee SM, Yim JJ, Yoo CG, Kim YW, Han SK, Yang SC. Prognosis in patients having chronic obstructive pulmonary disease with significant coronary artery lesion angina. Korean J Intern Med 2012; 27:189-96. [PMID: 22707891 PMCID: PMC3372803 DOI: 10.3904/kjim.2012.27.2.189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Revised: 02/14/2012] [Accepted: 02/17/2012] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS Many studies have investigated angina and its relationship with chronic obstructive pulmonary disease (COPD). However, angina was diagnosed only by noninvasive tests or only by clinical symptoms in most of these studies. The aim of this study was to compare the prognosis, including rate of hospitalization and death from significant coronary artery lesion and nonsignificant coronary artery lesion angina, in patients with COPD. METHODS Patients with COPD who underwent coronary angiography (CAG) due to angina were reviewed retrospectively at a tertiary referral hospital. COPD is defined as post-bronchodilator forced expiratory volume in 1 sec/forced vital capacity (FEV(1)/FVC) of < 70%. A significant coronary lesion is defined as at least 50% diameter stenosis of one major epicardial artery in CAG. RESULTS In total, 113 patients were enrolled. Mean follow-up duration was 39 ± 21 months. Of the patients, 52 (46%) had mild COPD and 48 (42%) had moderate COPD. Sixty-nine (61%) patients had significant stenosis in CAG. The death rate in the follow-up period was 2.21 per 100 patient-years. No significant difference was observed among the all-cause mortality rate, admission rate, or intensive care unit admission rate in patients who had COPD with or without significant coronary artery disease. Pneumonia or acute exacerbation of COPD was the most common cause of admission. CONCLUSIONS In patients having COPD with angina who underwent CAG, no significant difference was observed in mortality or admission events depending on the presence of a significant coronary artery lesion during the 2-year follow-up period.
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Affiliation(s)
- Tae Yun Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung Hee Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Kyoung Koo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Yeon Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Sang-Min Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jae-Jun Yim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Chul-Gyu Yoo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Young Whan Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Koo Han
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Seok-Chul Yang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
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BOSCHETTO PIERA, BEGHÉ BIANCA, FABBRI LEONARDOM, CECONI CLAUDIO. Link between chronic obstructive pulmonary disease and coronary artery disease: Implication for clinical practice. Respirology 2012; 17:422-31. [DOI: 10.1111/j.1440-1843.2011.02118.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Enriquez JR, Holper EM. Increased Adverse Events After Percutaneous Coronary Intervention in Patients With COPD: Response. Chest 2012. [DOI: 10.1378/chest.11-2914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Al Suwaidi J, Zubaid M, El-Menyar AA, Singh R, Asaad N, Sulaiman K, Al Mahmeed W, Al-Shereiqi S, Akbar M, Al Binali HA. Prevalence and outcome of cigarette and waterpipe smoking among patients with acute coronary syndrome in six Middle-Eastern countries. Eur J Prev Cardiol 2012; 19:118-25. [PMID: 21450616 DOI: 10.1177/1741826710393992] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2023]
Abstract
OBJECTIVE We evaluated the prevalence and effect of cigarette smoking (CS) and waterpipe (WP) smoking on patients with acute coronary syndrome (ACS) in six Middle-Eastern countries. METHODS Analysis of the Gulf Registry of Acute Coronary Events (Gulf RACE) survey, which included 6704 consecutive patients hospitalized with ACS, was made and patients were divided into four groups depending on whether they were smokers - cigarette-CS, waterpipe-WS, combined cigarette and waterpipe (CW) - or non-smokers (NS). RESULTS Overall 38% of patients were smokers; 4.4% of patients were waterpipe smokers (1.4% WS and 3% CW). When compared to the three smokers' groups, non-smokers were older. Overall, smokers had fewer cardiovascular risk factors when compared to NS. ST-segment elevation myocardial infarction was more common among nicotine smokers (CS 54.4%, WS 57.3%, 47.3% CW vs 30% NS, p = 0.001) while NS were more likely to have non-ST elevation ACS. Cigarette (and not waterpipe) smokers were more likely to present early and with typical symptoms when compared to NS and WS. Admission heart rate and blood pressures were higher in the non-smoker group and WS. Non-smokers and WS were also more likely to present with Killip class >1. After adjustment for baseline variables, smoking was not an independent predictor of adverse cardiac events. CONCLUSION Cigarette smoking is prevalent among Middle-Eastern patients presenting with acute coronary syndrome. Waterpipe smoking use is low; however it is relatively more frequent in women when compared to cigarette smoking. The current study underscores the need for further studies into the effects of different forms of nicotine smoking.
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Affiliation(s)
- Jassim Al Suwaidi
- Department of Cardiology, Hamad Medical Corporation, Qatar and Weill Cornell Medical College, Qatar.
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Stefan MS, Bannuru RR, Lessard D, Gore JM, Lindenauer PK, Goldberg RJ. The impact of COPD on management and outcomes of patients hospitalized with acute myocardial infarction: a 10-year retrospective observational study. Chest 2011; 141:1441-1448. [PMID: 22207679 DOI: 10.1378/chest.11-2032] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND There are limited data describing contemporary trends in the management and outcomes of patients with COPD who develop acute myocardial infarction (AMI). METHODS The study population consisted of patients hospitalized with AMI at all greater Worcester, Massachusetts, medical centers between 1997 and 2007. RESULTS Of the 6,290 patients hospitalized with AMI, 17% had a history of COPD. Patients with COPD were less likely to be treated with β-blockers or lipid-lowering therapy or to have undergone interventional procedures during their index hospitalization than patients without COPD. Patients with COPD were at higher risk for dying during hospitalization (13.5% vs 10.1%) and at 30 days after discharge (18.7% vs 13.2%), and their outcomes did not improve during the decade-long period under study. After multivariable adjustment, the adverse effects of COPD remained on both in-hospital (OR, 1.25; 95% CI, 0.99-1.50) and 30-day all-cause mortality (OR, 1.31; 95% CI, 1.10-1.58). The use of evidence-based therapies for all patients with AMI increased between 1997 and 2007, with a particularly marked increase for patients with COPD. CONCLUSIONS Our results suggest that the gap in medical care between patients with and without COPD hospitalized with AMI narrowed substantially between 1997 and 2007. Patients with COPD, however, remain less aggressively treated and are at increased risk for hospital adverse outcomes than patients without COPD in the setting of AMI. Careful consideration is necessary to ensure that these high-risk complex patients are not denied the benefits of effective cardiac therapies.
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Affiliation(s)
- Mihaela S Stefan
- Department of General Medicine, Baystate Medical Center, Springfield, MA; Tufts Clinical and Translational Science Institute, Tufts University School of Medicine, Boston, MA.
| | - Raveendhara R Bannuru
- Tufts Clinical and Translational Science Institute, Tufts University School of Medicine, Boston, MA
| | - Darleen Lessard
- Department of Quantitative Health Sciences, Worcester, MA; University of Massachusetts Medical School, Worcester, MA
| | - Joel M Gore
- Department of Medicine, Worcester, MA; University of Massachusetts Medical School, Worcester, MA
| | - Peter K Lindenauer
- Department of General Medicine, Baystate Medical Center, Springfield, MA; Tufts Clinical and Translational Science Institute, Tufts University School of Medicine, Boston, MA
| | - Robert J Goldberg
- Department of Quantitative Health Sciences, Worcester, MA; University of Massachusetts Medical School, Worcester, MA
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Bérard E, Bongard V, Roche N, Perez T, Brouquières D, Taraszkiewicz D, Fievez S, Denis F, Escamilla R, Ferrières J. Undiagnosed airflow limitation in patients at cardiovascular risk. Arch Cardiovasc Dis 2011; 104:619-26. [PMID: 22152514 DOI: 10.1016/j.acvd.2011.10.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Revised: 09/27/2011] [Accepted: 10/05/2011] [Indexed: 11/29/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) and cardiovascular diseases (CVD) share risk factors and impair each other's prognosis. AIMS To assess the prevalence of airflow limitation (AL) compatible with COPD in a population at cardiovascular risk and to identify determinants of AL. METHODS All consecutive patients referred to the cardiovascular prevention unit of a university hospital in 2009 were studied in a cross-sectional analysis. Patients answered questionnaires on socioeconomic status, medical history and lifestyle, and underwent extensive physical examinations, biological measures and spirometry testing. AL was defined as FEV1/FVC<0.70, without any history of asthma. Determinants of AL were assessed using logistic regression. RESULTS The sample comprised 493 participants (mean age 57.4±11.1 years); 60% were men, 18% were current smokers, 42% were ex-smokers and 10% of patients had a history of CVD. Ten-year risk of coronary heart disease (CHD) according to the Framingham equation was intermediate (10-20%) for 25% of patients and high (>20%) for 10%. Prevalence of AL was 5.9% (95% confidence interval [CI] 4.0-8.3%) in the whole population and 4.3% (2.6-6.6%) among subjects in primary cardiovascular prevention. AL was independently associated with CVD (adjusted odds ratio 4.18, 95% CI 1.72-10.15; P=0.002) but not with Framingham CHD risk. More than 80% of patients screened with AL had not been diagnosed previously and more than one in two patients was asymptomatic. CONCLUSION Patients with CVD are at increased risk of AL and thus should benefit from AL screening as they are frequently asymptomatic.
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Affiliation(s)
- Emilie Bérard
- UMR 1027 Inserm, Department of Epidemiology, Health Economics and Public Health, CHU de Toulouse, université de Toulouse, 31073 Toulouse cedex, France
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Lazzeri C, Valente S, Attanà P, Chiostri M, Picariello C, Gensini GF. The prognostic role of chronic obstructive pulmonary disease in ST-elevation myocardial infarction after primary angioplasty. Eur J Prev Cardiol 2011; 20:392-8. [PMID: 22023803 DOI: 10.1177/1741826711428243] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) has been reported as a common finding in patients with acute myocardial infarction but data on its prognostic role are still controversial. METHODS The present investigation was aimed at assessing the impact of COPD at short and long terms in 818 consecutive patients with ST-elevation myocardial infarction all submitted to percutaneous coronary intervention. RESULTS Patients with COPD were older (p < 0.001) and more frequently smokers (p = 0.019). They showed a reduced estimated glomerular filtration rate (eGFR; p = 0.004) and a higher incidence of a more advanced coronary artery disease (p = 0.004). Patients with COPD showed higher values of N-terminal pro-brain natriuretic peptide (p = 0.004), uric acid (p = 0.005), erythrocyte sedimentation rate (p = 0.002), fibrinogen (p = 0.004), and C-reactive protein positivity (p = 0.017). Kaplan-Meier survival curve documented a significantly worse outcome in COPD patients. When age was taken into account, COPD patients aged <75 years showed a significantly worse outcome at follow up when compared to non-COPD patients aged <75 years. At multivariate analysis, the following variables were independent predictors for death at follow up: age, eGFR, COPD, and discharge left ventricular ejection fraction. CONCLUSIONS In our series, while the presence of COPD was not significantly associated with an increased early mortality, COPD is an independent predictor of long-term mortality. In particular, long-term survival was significantly poorer in COPD patients <75 years in respect to non-COPD patients with the same age. Our data strongly suggest that age should be taken into account in the risk stratification of COPD patients with ST-elevation myocardial infarction.
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El-Menyar A, Zubaid M, Almahmeed W, Alanbaei M, Rashed W, Al Qahtani A, Singh R, Zubair S, Al Suwaidi J. Initial hospital pulse pressure and cardiovascular outcomes in acute coronary syndrome. Arch Cardiovasc Dis 2011; 104:435-43. [DOI: 10.1016/j.acvd.2011.05.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Revised: 05/09/2011] [Accepted: 05/09/2011] [Indexed: 11/26/2022]
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Suskovic S, Kosnik M, Lainscak M. Heart failure and chronic obstructive pulmonary disease: Two for tea or tea for two? World J Cardiol 2010; 2:305-7. [PMID: 21160607 PMCID: PMC2999042 DOI: 10.4330/wjc.v2.i10.305] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Revised: 09/17/2010] [Accepted: 09/24/2010] [Indexed: 02/06/2023] Open
Abstract
A combination of chronic obstructive pulmonary disease (COPD) and heart failure (HF) is common yet it is inadequately and rarely recognized. Because of the similar clinical manifestations, comorbidity is frequently not considered and appropriate diagnostic tests are not performed. It is very important that a combination of COPD and HF is recognized as these patients have a worse prognosis than patients with an individual disease. When present, COPD should not prevent the use of life-saving therapy in patients with HF, particularly β-blockers. Despite clear evidence of the safety and tolerability of cardioselective β-blockers in COPD patients, these drugs remain grossly underprescribed and underdosed. Routine spirometry and echocardiography in HF and COPD patients, respectively, is therefore warranted to improve current clinical practice.
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Affiliation(s)
- Stanislav Suskovic
- Stanislav Suskovic, Department for Clinical Audit, University Clinic for Respiratory and Allergic Diseases Golnik, SI-4204 Golnik, Slovenia
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