Impact of chronic obstructive pulmonary disease on the outcomes of patients with peripheral artery disease.

Abstract

Peripheral artery disease (PAD) and chronic obstructive pulmonary disease (COPD) are both related with high in-hospital mortality. We aimed to investigate the impact of COPD on the in-hospital outcomes in PAD. PAD patients were selected based on ICD-code I70.2 of the German nationwide database, stratified for COPD and compared regarding adverse in-hospital outcomes. Between 01/2005-12/2015, 5,611,827 inpatients (64.8% males) were diagnosed with PAD; of those, 13.6% were coded additionally with COPD. Overall, 277,894 PAD patients (5.0%) died during in-hospital course. Prevalence of cardiovascular diseases as well as cancer (12.1% vs. 7.0%, P < 0.001) was higher in PAD patients with COPD compared to PAD patients without COPD. PAD patients with COPD showed more often lower PAD stages according to Fontaine classification (PAD stage I: 27.1% vs. 19.3%, P < 0.001; PAD stage IIa: 34.9% vs. 35.5%, P < 0.001; PAD stage IIb: 14.5% vs. 13.6%, P < 0.001; PAD stage III: 11.8% vs. 14.8%, P < 0.001; PAD stage IV: 13.8% vs. 19.6%, P < 0.001). The all-cause in-hospital mortality was significantly higher in PAD patients with COPD compared to those without COPD (6.5% vs. 4.7%, P < 0.001). Cardiovascular events comprising pulmonary embolism and myocardial infarction occurred more often in coprevalence with PAD and COPD. COPD was an independent predictor of in-hospital death (OR 1.16 (95%CI 1.15-1.17) P < 0.001) and an independent predictor for pulmonary embolism (PE, OR 1.44 (1.40-1.49), P < 0.001) in PAD patients. COPD was associated with a high in-hospital mortality in PAD patients probably driven by higher frequencies of PE and cancer.