慢性阻塞性肺疾病和冠状动脉疾病的全球洞察：对640万患者的系统评价和荟萃分析
Global Insights into Chronic Obstructive Pulmonary Disease and Coronary Artery Disease: A Systematic Review and Meta-Analysis of 6,400,000 Patients.
作者信息
Zheng Yitian, Hu Zhenliang, Seery Samuel, Li Chen, Yang Jie, Wang Wenyao, Qi Yu, Shao Chunli, Fu Yi, Xiao Han, Tang Yi-Da
机构信息
Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital; NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides; Key Laboratory of Molecular Cardiovascular Science, Ministry of Education; Beijing Key Laboratory of Cardiovascular Receptors Research, 100191 Beijing, China.
Research Unit of Medical Science Research Management/Basic and Clinical Research of Metabolic Cardiovascular Diseases, Chinese Academy of Medical Sciences, 100021 Beijing, China.
出版信息
Rev Cardiovasc Med. 2024 Jan 15;25(1):25. doi: 10.31083/j.rcm2501025. eCollection 2024 Jan.
BACKGROUND
The high prevalence of chronic obstructive pulmonary disease (COPD) in coronary artery disease (CAD) has been acknowledged over the past decade, although the cause/s remain uncertain due to differences in diagnoses. COPD has also become a leading CAD comorbidity, although again little is known about its interactions. This meta-analysis explored COPD prevalence in the global CAD population, as well as the influence of COPD on CAD.
METHODS
PubMed, Web of Science, Embase, and grey literature were searched until 26th November 2021. The prevalence of COPD was calculated, and data were grouped according to COPD diagnostic methods, interventions, region, economic status, etc. Outcomes including all-cause death, cardiac death, myocardial infarction, revascularization, stroke, heart failure, and respiratory failure were analyzed. This study was registered with PROSPERO (CRD No.42021293270).
RESULTS
There was an average prevalence of 14.2% for COPD in CAD patients (95% CI: 13.3-15.1), with diagnostics of COPD through spirometry, International Classification of the Diseases (ICD codes), and self-reported methods. Comorbid COPD-CAD patients were more likely to be smokers and suffer from cardiovascular and respiratory complications (all odds ratios [OR] 1). COPD-CAD has higher mortality (hazard ratio [HR] 2.81, 95% CI: 2.40-3.29), and myocardial infarction, stroke, and respiratory failure rates (all HR 1). Coronary artery bypass graft (CABG) reduces the need for revascularization (HR 0.43, 95% CI: 0.20-0.94) compared to percutaneous coronary intervention (PCI), without increasing mortality.
CONCLUSIONS
The global prevalence of COPD is particularly high in CAD patients. COPD-CAD patients are more likely to encounter cardiovascular and respiratory complications and endure poorer outcomes. Limited evidence suggests that CABG may reduce the need for revascularization without increasing mortality, although further research is required to confirm these observations.
背景
在过去十年中，冠状动脉疾病（CAD）患者中慢性阻塞性肺疾病（COPD）的高患病率已得到公认，尽管由于诊断差异，其病因仍不确定。COPD也已成为CAD的主要合并症，尽管对其相互作用仍知之甚少。这项荟萃分析探讨了全球CAD人群中COPD的患病率，以及COPD对CAD的影响。
方法
检索了截至2021年11月26日的PubMed、科学网、Embase和灰色文献。计算了COPD的患病率，并根据COPD诊断方法、干预措施、地区、经济状况等对数据进行分组。分析了包括全因死亡、心源性死亡、心肌梗死、血运重建、中风、心力衰竭和呼吸衰竭在内的结局。本研究已在PROSPERO注册（注册号：CRD No.42021293270）。
结果
CAD患者中COPD的平均患病率为14.2%（95%CI：13.3-15.1），诊断方法包括肺功能测定、国际疾病分类（ICD编码）和自我报告法。合并COPD的CAD患者更有可能是吸烟者，并患有心血管和呼吸系统并发症（所有比值比[OR]均>1）。COPD合并CAD的患者死亡率更高（风险比[HR]2.81，95%CI：2.40-3.29），心肌梗死、中风和呼吸衰竭发生率也更高（所有HR均>1）。与经皮冠状动脉介入治疗（PCI）相比，冠状动脉旁路移植术（CABG）减少了血运重建的需求（HR 0.43，95%CI：0.20-0.94），且不增加死亡率。
结论
CAD患者中COPD的全球患病率特别高。合并COPD的CAD患者更有可能遭遇心血管和呼吸系统并发症，且预后较差。有限的证据表明，CABG可能减少血运重建的需求且不增加死亡率，尽管需要进一步研究来证实这些观察结果。
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