Chronic obstructive pulmonary disease—An independent risk factor for long-term cardiac and cardiovascular mortality in patients with ischemic heart disease

Abstract

Background Limited data are available on long-term mortality and morbidity of patients with chronic obstructive pulmonary disease (COPD) and ischemic heart disease. We examined how COPD affects long-term mortality and morbidity after undergoing percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). Methods We analyzed 9877 consecutive patients who underwent their first elective PCI ( n = 6878) and CABG ( n = 2999) in 2000–2002 at 30 institutions listed in the CREDO–Kyoto registry. Results COPD was diagnosed in 240 patients (2.4%). In-hospital mortality (1.3% vs. 1.2%, p = 0.972) did not differ between patients with and without COPD. During long-term follow-up (42. 8 month s), 906 patients (9.4%) died, 517 (5.3%) of whom died of cardiovascular death and 376 (3.9%), of cardiac death. At 3 years, the unadjusted survival rate and the rates of freedom from cardiovascular death and cardiac death were 92.1%, 95.3%, and 96.5% in the total population and 82.8%, 91.7%, and 92.1% in patients with COPD respectively. Log-rank test indicated that COPD was associated with higher incidence of all-cause mortality ( p < 0.0001), cardiovascular death ( p = 0.0002), and cardiac death ( p < 0.0001). Multivariate analyses indicated that COPD was an independent predictor of all-cause mortality (hazard ratio 1.36, p = 0.0003), cardiovascular death (hazard ratio 1.28, p = 0.0407), and cardiac death (hazard ratio 1.48, p = 0.003). Conclusions COPD is an independent risk factor for long-term cardiac and cardiovascular mortality in patients with ischemic heart disease.