Abstract
Pneumoconiosis (PNC) is a major occupational disease that develops as a result of occupational exposure to dust via inhalation. In addition to its harmful effects on the respiratory system, PNC can increase vulnerability to coronary heart disease (CHD)—the leading cause of death in the United States and in the world. Currently, two types of cardiovascular intervention procedures for CHD treatment are percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). The objective of this study was to investigate comparative effectiveness of the two major cardiovascular intervention procedures—PCI and CABG—in PNC patients with CHD. Data from 1094 hospitalizations of adult patients with PNC and CHD (CHD-PNC patients) and 534,120 hospi-talizations of CHD patients without PNC (CHD-nonPNC) were investigated. Adjusted odds ratios for in-hospital death in relation to the type of procedure, adjusted for patient socio-demographic and clinical characteristics and hospital characteristics, were calculated using multivariable logistic regression. Men constituted 97.8% of CHD-PNC patients and 68.6% of CHD-nonPNC patients. Within the CHD-PNC group, crude (unadjusted) in-hospital mortality after CABG and PCI did not differ significantly (1.35% vs. 2.00%, p = 0.425) and remained insignificant in the multivariable analysis, adjusted for patient and hospital characteristics (adjusted OR = 0.714, 95% CI 0.220 - 2.323, p = 0.576). But in the CHD-nonPNC group, in-hospital mortality after CABG was significantly higher than after PCI both in crude analysis (2.83% vs. 1.28%, p
Highlights
Pneumoconiosis is a major occupational disease that develops as a result of occupational exposure to dust via inhalation
We identified a total of 535,214 hospitalizations of coronary heart disease (CHD) patients 21 years of age and older who underwent either coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI)
Due to their extremely small numbers that can compromise the parsimony of the statistical models and because gender is a known confounder in studies of CHD, we utilized restriction as an established method of confounding control and did not include women in further multivariable analyses
Summary
Pneumoconiosis is a major occupational disease that develops as a result of occupational exposure to dust via inhalation. Strict medical definitions suggest that only interstitial lung diseases caused by inorganic dust belong to this group (such as coal dust, silica, asbestos, aluminum, beryllium, talc) [2], other authorities extend the definition of pneumoconiosis to include organic dusts, such as byssinosis which is caused by cotton dust [1]. Most pneumoconioses share some common pathophysiological mechanisms that include excessive development of fibrous (i.e., scar) tissue in the lungs—pneumofibrosis—that restricts respiratory lung capacity. What makes pneumoconiosis a dangerous disease is that a) once pneumofibrosis is initiated, it may continue progressing even after the dust exposure is discontinued; and b) no effective treatment for pneumoconiosisis currently available [2] [3]. Prevention and reduction of work-related interstitial lung diseases is a strategic goal of the National Institute’s for Occupational Safety and Health (NIOSH) Respiratory Disease Research Program [4]
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