The association between recent hospitalized COPD exacerbations and adverse outcomes after percutaneous coronary intervention: a nationwide cohort study

Abstract

Purpose

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

Patients and methods

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

Results

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

Conclusion

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

Keywords:

• chronic obstructive pulmonary disease (COPD)
• exacerbation
• percutaneous coronary intervention (PCI)
• cardiovascular outcomes

Supplementary material

Table S1 ICD, Ninth Revision, Clinical Modification (ICD-9-CM) codes of procedures, comorbidities, and adverse outcomes

Acknowledgments

The authors are grateful to Sheau-Chiann Chen, PhD, for providing the statistical consulting services from the Center for Quantitative Sciences, Vanderbilt University Medical Center, Nashville, USA. This work was supported by National Cheng Kung University Hospital, Tainan, Taiwan (NCKUH-10503025 to CHL and NCKUH-10706007 to WCL).

Author contributions

CYL and CHL were the guarantors of this paper. WCL, CWC, WWL, MHH, LMT, CYL, and CHL helped in the study concept and design. All authors performed the acquisition and interpretation of data. WCL, CYL, and CHL helped in drafting of the manuscript. CLL, CYL, and CHL performed the statistical analysis. CYL and CHL were involved in the study supervision. All authors contributed to data analysis, drafting or revising the article, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.