Late Breaking Abstract - Chronic coronary artery disease and decline of lung function as predictors of mortality and exacerbation risk in stable COPD: Results from COSYCONET

Abstract

<b>Aims and Objectives:</b> The present study evaluated the role of cardiac diseases and decline of lung function measures for mortality in COPD and compared this with their role for exacerbation risk. <b>Methods:</b> Data from baseline and up to 4 follow-up visits of the COSYCONET cohort were used. Cox regression analysis was used to determine the relationship of predictors to mortality, and in a parallel manner logistic regression for exacerbation risk. Predictors comprised major, including cardiovascular, comorbidities, baseline lung function (spirometry, CO diffusing capacity) and its annual decline in %predicted, symptoms and exacerbations at baseline, a physical activity score and cardiovascular medication. <b>Results:</b> Overall, 1817 patients of GOLD grades 1-4 fulfilled the inclusion criteria. Coronary artery disease without reported infarction, as indicator of chronic heart disease, was linked to mortality (p=0.005; hazard ratio HR 1.97, 95%CI: 1.22, 3.16), irrespective of cardiac function being in the normal range for the great majority of patients. It was not associated with exacerbation risk. Mortality was additionally linked to the decline of lung diffusing capacity (TLCO, p=0.001), a marker of emphysema, but not to that of FEV1 (p=0.138). Conversely, exacerbation risk was related to the decline of FEV1 (p=0.003) but not to that of TLCO (p=0.138). <b>Conclusions:</b> Chronic coronary artery disease significantly contributed to mortality risk in COPD even in the absence of impaired cardiac function. Moreover, for mortality the time course of lung diffusing capacity was more relevant than that of airway obstruction, in contrast to exacerbation risk.