Zheng Yitian, Qi Yu, Seery Samuel, Wang Wenyao, Zhao Wei, Shen Tao, Zhou Lequn, Yang Jie, Li Chen, Wang Xuliang, Gao Jun, Meng Xiangbin, Dong Erdan, Tang Yi-Da
Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Front Cardiovasc Med. 2022 Jun 9;9:827635. doi: 10.3389/fcvm.2022.827635. eCollection 2022.
The aim of this study was to analyze long-term outcomes of Chinese coronary artery disease (CAD) patients with (and without) chronic obstructive pulmonary disease (COPD) after percutaneous coronary intervention (PCI).
Chronic obstructive pulmonary disease is a chronic condition which often develops in conjunction with CAD. PCI is a core therapy for CAD, although we still need to understand CAD-COPD outcomes and to identify factors that influence prognoses, across ethnicities.
This double-cohort study involved 12,343 Chinese CAD patients who received PCI. Baseline characteristics were collected in two independent, specialty centers. Propensity-score matching was performed to control confounding factors, using a nearest neighbor matching method within a 0.02 caliper and on a propensity score scale of 0.1 for each center. Comorbid CAD-COPD cases were compared to non-COPD patients in terms of major adverse cardiac events (MACEs).
Patients with COPD were generally older than those without COPD (65.4 ± 9.2 vs. 58.2 ± 10.3, < 0.001). There were no significant differences in the end points between COPD and non-COPD groups after PCI (All > 0.05); however, the incidence of MACEs increased after 450 days. Further subgroup analysis suggests that COPD is approximately four times more prevalent among those aged over 75 years (HR, 3.818; 95%CI, 1.10-13.29; = 0.027) and those aged below 55 years (HR = 4.254; 95% CI, 1.55-11.72; = 0.003).
Having COPD does not appear to have a significant impact on CAD outcomes 2 years after PCI, and beyond. However, an increasing number of MACEs was observed after 450 days, which suggests that there may be a double-stage effect of COPD on PCI prognosis. There is a need for focused comorbidity management, specifically for those aged below 55 years and above 75 years.
本研究旨在分析经皮冠状动脉介入治疗（PCI）后合并（或不合并）慢性阻塞性肺疾病（COPD）的中国冠心病（CAD）患者的长期预后。
慢性阻塞性肺疾病是一种常与冠心病同时发生的慢性疾病。PCI是冠心病的核心治疗方法，尽管我们仍需了解冠心病合并COPD的预后情况，并确定影响不同种族患者预后的因素。
这项双队列研究纳入了12343例接受PCI的中国冠心病患者。在两个独立的专科中心收集基线特征。采用倾向评分匹配法控制混杂因素，在每个中心使用0.02卡尺内的最近邻匹配法和0.1的倾向评分量表。将合并CAD-COPD的病例与非COPD患者在主要不良心脏事件（MACE）方面进行比较。
COPD患者通常比无COPD患者年龄更大（65.4±9.2岁对58.2±10.3岁，<0.001）。PCI后COPD组和非COPD组的终点指标无显著差异（均>0.05）；然而，450天后MACE的发生率增加。进一步的亚组分析表明，COPD在75岁以上人群（HR，3.818；95%CI，1.10-13.29；=0.027）和55岁以下人群（HR=4.254；95%CI，1.55-11.72；=0.003）中的患病率约高四倍。
合并COPD似乎在PCI后2年及以后对冠心病预后没有显著影响。然而，450天后观察到MACE数量增加，这表明COPD可能对PCI预后有双阶段影响。需要对合并症进行针对性管理，特别是针对55岁以下和75岁以上的人群。
