Prevalence and underdiagnosis of COPD in patients with ischemic heart disease demonstrated by coronary angiography. Prognostic implications

Abstract

Introduction: Retrospective studies based on clinical data and without spirometric confirmation suggest a poor prognosis of patients with ischemic heart disease (IHD) and chronic obstructive pulmonary disease (COPD) following percutaneous coronary intervention (PCI). Impact of undiagnosed COPD in these patients is unknown. The aim of our study was to evaluate the prevalence of COPD in patients with IHD treated with PCI, and prognosis impact of COPD –previously or newly diagnosed- in these patients. Material and Methods: Patients with IHD confirmed by PCI were consecutively included. After PCI, the pacients underwent forced spirometry and evaluation of cardiovascular risk factors. Mortality, new cardiovascular events, and their combined endpoint were analyzed. Results: A total of 133 patients (78% male), with a mean (SD) age of 63 (10.12) years were included. Out of the whole group, 33 (24.8%) met the spirometric criteria for COPD, of which 81.8% were undiagnosed. IHD patients with COPD were older, had more coronary vessels affected and a greater history of previous IHD. Median follow-up was 934 days (IQR 25-75%: 546-1160). COPD patients had greater mortality (p=0.008; H.R. 8.85; CI 95%:1.76-44.47) and number of cardiovascular events (p=0.024; H.R. 1.87; CI 95%: 1.04-3.33), even those without a previous diagnosis of COPD (p=0.01; H.R.: 1.78; CI 95%: 1.12-2.83). These differences remained after adjustment for possible confounding variables. Conclusions: Prevalence and underdiagnosis of COPD in patients with IHD who undergo PCI are both high. These patients showed greater mortality and a higher number of cardiovascular events during follow-up.