Division of Cardiology, Detroit Medical Center, Wayne State University, Detroit, MI, USA.
Division of Internal Medicine, Englewood Hospital and Medical Center, Seton Hall University-Hackensack Meridian School of Medicine, Englewood, NJ, USA.
Angiology. 2020 Apr;71(4):372-379. doi: 10.1177/0003319719877096. Epub 2019 Oct 2.
Chronic obstructive pulmonary disease (COPD) is a risk factor for non-ST-segment elevation-acute coronary syndromes (NSTE-ACS). Whether early invasive strategy (EIS) or ischemia-guided strategy (IGS) confers better outcomes in NSTE-ACS with COPD is largely unknown. Nationwide Inpatient Sample database of the United States was queried from 2010 to 2015 to identify NSTE-ACS with and without COPD. Early invasive strategy was defined as coronary angiogram with or without revascularization on admission day 0 or 1, whereas IGS included patients who did not receive EIS. Standardized morbidity ratio weight was used to calculate the adjusted odds ratio. A total of 228 175 NSTE-ACS admissions with COPD were identified of which 34.0% received EIS. In-hospital mortality was lower with EIS in patients with COPD (3.1% vs 5.5%, adjusted odds ratio 0.57, 95% confidence interval 0.50-0.63) compared to IGS, but the magnitude of mortality reduction observed in EIS in patients with COPD was less compared to non-COPD patients ( = .02). Length of stay was shorter (4.2 vs 4.7 days, < .0001) but the cost was higher (US$23 804 vs US$18 533, < .0001) in EIS in COPD. Early invasive strategy resulted in lower in-hospital mortality and marginally shorter length of stay but higher hospitalization cost in NSTE-ACS with COPD.
慢性阻塞性肺疾病（COPD）是无 ST 段抬高急性冠状动脉综合征（NSTE-ACS）的一个危险因素。在 COPD 合并 NSTE-ACS 患者中，早期侵入性策略（EIS）或缺血指导策略（IGS）是否能带来更好的结局尚不清楚。本研究在美国国家住院患者样本数据库中检索了 2010 年至 2015 年 NSTE-ACS 合并和不合并 COPD 的患者数据。EIS 定义为入院第 0 或 1 天进行冠状动脉造影并进行血运重建，IGS 包括未接受 EIS 的患者。采用标准化发病率比权重来计算调整后的比值比。共纳入 228175 例合并 COPD 的 NSTE-ACS 患者，其中 34.0%接受了 EIS。与 IGS 相比，EIS 可降低 COPD 患者的院内死亡率（3.1%比 5.5%，调整后的比值比 0.57，95%置信区间 0.50-0.63），但与非 COPD 患者相比，EIS 降低 COPD 患者死亡率的幅度较小（ =.02）。EIS 组的住院时间更短（4.2 天比 4.7 天， <.0001），但费用更高（23804 美元比 18533 美元， <.0001）。在 COPD 合并 NSTE-ACS 患者中，EIS 可降低院内死亡率，适度缩短住院时间，但增加住院费用。
