Division of Clinical and Experimental Cardiology, AOU Sassari, Sassari, Italy.
University of Sassari, Sassari, Italy.
Respir Res. 2022 Aug 15;23(1):207. doi: 10.1186/s12931-022-02128-0.
Chronic obstructive pulmonary disease (COPD) is projected to become the third cause of mortality worldwide. COPD shares several pathophysiological mechanisms with cardiovascular disease, especially atherosclerosis. However, no definite answers are available on the prognostic role of COPD in the setting of ST elevation myocardial infarction (STEMI), especially during COVID-19 pandemic, among patients undergoing primary angioplasty, that is therefore the aim of the current study.
In the ISACS-STEMI COVID-19 registry we included retrospectively patients with STEMI treated with primary percutaneous coronary intervention (PCI) between March and June of 2019 and 2020 from 109 high-volume primary PCI centers in 4 continents.
A total of 15,686 patients were included in this analysis. Of them, 810 (5.2%) subjects had a COPD diagnosis. They were more often elderly and with a more pronounced cardiovascular risk profile. No preminent procedural dissimilarities were noticed except for a lower proportion of dual antiplatelet therapy at discharge among COPD patients (98.9% vs. 98.1%, P = 0.038). With regards to short-term fatal outcomes, both in-hospital and 30-days mortality occurred more frequently among COPD patients, similarly in pre-COVID-19 and COVID-19 era. However, after adjustment for main baseline differences, COPD did not result as independent predictor for in-hospital death (adjusted OR [95% CI] = 0.913[0.658-1.266], P = 0.585) nor for 30-days mortality (adjusted OR [95% CI] = 0.850 [0.620-1.164], P = 0.310). No significant differences were detected in terms of SARS-CoV-2 positivity between the two groups.
This is one of the largest studies investigating characteristics and outcome of COPD patients with STEMI undergoing primary angioplasty, especially during COVID pandemic. COPD was associated with significantly higher rates of in-hospital and 30-days mortality. However, this association disappeared after adjustment for baseline characteristics. Furthermore, COPD did not significantly affect SARS-CoV-2 positivity.
NCT04412655 (2nd June 2020).
慢性阻塞性肺疾病（COPD）预计将成为全球第三大致死原因。COPD 与心血管疾病（尤其是动脉粥样硬化）有许多共同的病理生理机制。然而，在接受直接经皮冠状动脉介入治疗（PCI）的 ST 段抬高型心肌梗死（STEMI）患者中，COPD 的预后作用尚无明确答案，尤其是在 COVID-19 大流行期间，这就是当前研究的目的。
在 ISACS-STEMI COVID-19 登记研究中，我们回顾性纳入了 2019 年 3 月至 6 月和 2020 年来自四大洲 109 个高容量直接 PCI 中心的 STEMI 患者，这些患者接受了直接 PCI 治疗。
本分析共纳入 15686 例患者。其中，810 例（5.2%）患者被诊断为 COPD。他们更常见于老年人群，且心血管风险状况更为明显。除 COPD 患者出院时双抗血小板治疗比例较低（98.9% vs. 98.1%，P=0.038）外，两组间并无明显的操作差异。在短期致命结局方面，COPD 患者的院内和 30 天死亡率均较高，且在 COVID-19 大流行之前和之后时期均如此。然而，在校正主要基线差异后，COPD 并未成为院内死亡的独立预测因素（校正比值比[95%CI]为 0.913[0.658-1.266]，P=0.585）或 30 天死亡率的独立预测因素（校正比值比[95%CI]为 0.850[0.620-1.164]，P=0.310）。两组间 SARS-CoV-2 阳性率无显著差异。
这是研究接受直接 PCI 的 STEMI 合并 COPD 患者特征和结局的最大规模研究之一，尤其是在 COVID 大流行期间。COPD 与更高的院内和 30 天死亡率显著相关。然而，在校正基线特征后，这种相关性消失了。此外，COPD 对 SARS-CoV-2 阳性率无显著影响。
NCT04412655（2020 年 6 月 2 日）。
