Chronic obstructive pulmonary disease--an independent risk factor for long-term cardiac and cardiovascular mortality in patients with ischemic heart disease.
BACKGROUND
Limited data are available on long-term mortality and morbidity of patients with chronic obstructive pulmonary disease (COPD) and ischemic heart disease. We examined how COPD affects long-term mortality and morbidity after undergoing percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG).


METHODS
We analyzed 9877 consecutive patients who underwent their first elective PCI (n=6878) and CABG (n=2999) in 2000-2002 at 30 institutions listed in the CREDO-Kyoto registry.


RESULTS
COPD was diagnosed in 240 patients (2.4%). In-hospital mortality (1.3% vs. 1.2%, p=0.972) did not differ between patients with and without COPD. During long-term follow-up (42. 8 month s), 906 patients (9.4%) died, 517 (5.3%) of whom died of cardiovascular death and 376 (3.9%), of cardiac death. At 3 years, the unadjusted survival rate and the rates of freedom from cardiovascular death and cardiac death were 92.1%, 95.3%, and 96.5% in the total population and 82.8%, 91.7%, and 92.1% in patients with COPD respectively. Log-rank test indicated that COPD was associated with higher incidence of all-cause mortality (p<0.0001), cardiovascular death (p=0.0002), and cardiac death (p<0.0001). Multivariate analyses indicated that COPD was an independent predictor of all-cause mortality (hazard ratio 1.36, p=0.0003), cardiovascular death (hazard ratio 1.28, p=0.0407), and cardiac death (hazard ratio 1.48, p=0.003).


CONCLUSIONS
COPD is an independent risk factor for long-term cardiac and cardiovascular mortality in patients with ischemic heart disease.
Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara-chou, Shougoin, Sakyo-ku, Kyoto 606-8397, Japan. keinishi@kuhp.kyoto-u.ac.jp
Kei
K
Nishiyama
Takeshi
T
Morimoto
Yutaka
Y
Furukawa
Yoshihisa
Y
Nakagawa
Natsuhiko
N
Ehara
Ryouji
R
Taniguchi
Neiko
N
Ozasa
Naritatsu
N
Saito
Kozo
K
Hoshino
Masanao
M
Touma
Toshihiro
T
Tamura
Yoshisumi
Y
Haruna
Satoshi
S
Shizuta
Takahiro
T
Doi
Masanori
M
Fukushima
Toru
T
Kita
Takeshi
T
Kimura
D015906:Angioplasty, Balloon, Coronary / Q000401:mortality*; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D009017:Morbidity; D017202:Myocardial Ischemia / Q000401:mortality* / Q000601:surgery / Q000628:therapy; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality*; D012042:Registries; D012307:Risk Factors