title: Increased adverse events after percutaneous coronary intervention in patients with COPD: insights from the National Heart, Lung, and Blood Institute dynamic registry.
abstract: BACKGROUND
  Previous studies have demonstrated that patients with COPD are at higher risk for death after percutaneous coronary intervention (PCI), but other clinical outcomes and possible associations with adverse events have not been described.
  
  
  METHODS
  Using waves 1 through 5 (1999-2006) of the National Heart, Lung, and Blood Institute Dynamic Registry, patients with COPD (n = 860) and without COPD (n = 10,048) were compared. Baseline demographics, angiographic characteristics, and in-hospital and 1-year adverse events were compared.
  
  
  RESULTS
  Patients with COPD were older (mean age 66.8 vs 63.2 years, P < .001), more likely to be women, and more likely to have a history of diabetes, prior myocardial infarction, peripheral arterial disease, renal disease, and smoking. Patients with COPD also had a lower mean ejection fraction (49.1% vs 53.0%, P < .001) and a greater mean number of significant lesions (3.2 vs 3.0, P = .006). Rates of in-hospital death (2.2% vs 1.1%, P = .003) and major entry site complications (6.6% vs 4.2%, P < .001) were higher in pulmonary patients. At discharge, pulmonary patients were significantly less likely to be prescribed aspirin (92.4% vs 95.3%, P < .001), β-blockers (55.7% vs 76.2%, P < .001), and statins (60.0% vs 66.8%, P < .001). After adjustment, patients with COPD had significantly increased risk of death (hazard ratio [HR] = 1.30, 95% CI = 1.01-1.67) and repeat revascularization (HR = 1.22, 95% CI = 1.02-1.46) at 1 year, compared with patients without COPD.
  
  
  CONCLUSIONS
  COPD is associated with higher mortality rates and repeat revascularization within 1 year after PCI. These higher rates of adverse outcomes may be associated with lower rates of guideline-recommended class 1 medications prescribed at discharge.
authors.affiliation: Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Enriquez
authors.affiliation: Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Shailja V
authors.initials: SV
authors.lastname: Parikh
authors.affiliation: Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Faith
authors.initials: F
authors.lastname: Selzer
authors.affiliation: Division of Cardiology, Boston University Medical Center, Boston, MA.
authors.forename: Alice K
authors.initials: AK
authors.lastname: Jacobs
authors.affiliation: Division of Cardiology, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Oscar
authors.initials: O
authors.lastname: Marroquin
authors.affiliation: Division of Cardiology, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Suresh
authors.initials: S
authors.lastname: Mulukutla
authors.affiliation: Division of Cardiology, Jack D. Weiler/Montefiore Medical Center, Bronx, NY.
authors.forename: Vankeepuram
authors.initials: V
authors.lastname: Srinivas
authors.affiliation: Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX. Electronic address: Elizabeth.Holper@UTSouthwestern.edu.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Holper
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D015897:Comorbidity; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000453:epidemiology* / Q000628:therapy*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000453:epidemiology; D009204:Myocardial Revascularization / Q000706:statistics & numerical data; D054555:National Heart, Lung, and Blood Institute (U.S.); D017063:Outcome Assessment, Health Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology; D012042:Registries; D019233:Retreatment; D013318:Stroke Volume; D014481:United States