Department of Cardiology, Clinical Sciences, Lund University and Skåne University Hospital, Lund, Sweden.
Department of Cardiothoracic Surgery, Clinical Sciences, Lund University and Skåne University Hospital, Lund, Sweden.
Eur J Cardiothorac Surg. 2017 Nov 1;52(5):930-936. doi: 10.1093/ejcts/ezx219.
Patients with chronic obstructive pulmonary disease (COPD) who also have acute coronary syndromes are a high-risk population with a high mortality rate. Little is known about these patients following coronary artery bypass grafting (CABG).
Patients presenting with acute coronary syndromes between 2006 and 2014 with an angiogram showing 3-vessel disease or left main coronary artery involvement who were treated with CABG or percutaneous coronary intervention (PCI) only were included from the nationwide SWEDEHEART registry. Patients were stratified according to COPD status and compared with regard to outcome. The primary end-point was the 5-year mortality rate; secondary outcomes were the 30-day mortality rate and in-hospital complications after CABG.
We identified 6985 patients in the population who had CABG (COPD prevalence = 8.0%) and 14 209 who had PCI only (COPD = 8.2%). Patients with COPD were older and had more comorbidities than patients without COPD. The 5-year mortality rate was nearly doubled in patients with COPD versus patients without COPD (CABG: 27.2% vs 14.5%, P < 0.001; PCI only: 50.1% vs 29.1%, P < 0.001). After adjusting for age, sex and comorbidities, patients with COPD in both CABG-treated [hazard ratio = 1.52 (1.25-1.86), P < 0.001] and PCI-treated populations still had a significantly higher 5-year mortality rate. COPD was also independently associated with significantly more postoperative infections in need of antibiotics [odds ratio = 1.48 (1.07-2.04), P = 0.017] and pneumonia [odds ratio = 2.21 (1.39-3.52), P = 0.001].
Patients with COPD presenting with acute coronary syndromes and severe coronary artery disease are a high-risk population following CABG or PCI only, with higher risk of long-term and short-term death and postoperative infections. Preventive measures, including careful monitoring for signs of infection and prompt antibiotic treatment when indicated, should be considered.
患有慢性阻塞性肺疾病（COPD）的急性冠状动脉综合征患者是死亡率较高的高危人群。对于接受冠状动脉旁路移植术（CABG）治疗的此类患者，我们知之甚少。
我们从全国性的 SWEDEHEART 注册研究中纳入了 2006 年至 2014 年间因急性冠状动脉综合征就诊且血管造影显示 3 支血管病变或左主干冠状动脉受累而仅接受 CABG 或经皮冠状动脉介入治疗（PCI）的患者。根据 COPD 情况对患者进行分层，并比较其结局。主要终点是 5 年死亡率；次要终点是 CABG 后的 30 天死亡率和住院并发症。
我们在该人群中发现 6985 例接受 CABG（COPD 患病率=8.0%）和 14209 例仅接受 PCI（COPD=8.2%）的患者。与无 COPD 的患者相比，COPD 患者年龄更大，合并症更多。与无 COPD 的患者相比，有 COPD 的患者 5 年死亡率几乎翻了一番（CABG：27.2% vs 14.5%，P<0.001；仅 PCI：50.1% vs 29.1%，P<0.001）。在校正年龄、性别和合并症后，在接受 CABG 治疗的患者[风险比=1.52（1.25-1.86），P<0.001]和接受 PCI 治疗的患者中，COPD 患者的 5 年死亡率仍显著更高。COPD 还与术后需要抗生素治疗的感染[优势比=1.48（1.07-2.04），P=0.017]和肺炎[优势比=2.21（1.39-3.52），P=0.001]的发生显著相关。
患有 COPD 的急性冠状动脉综合征和严重冠状动脉疾病患者在接受 CABG 或仅接受 PCI 治疗后属于高危人群，其长期和短期死亡风险以及术后感染风险更高。应考虑采取预防措施，包括密切监测感染迹象，并在需要时及时给予抗生素治疗。
