title: Underdiagnosis and prognosis of chronic obstructive pulmonary disease after percutaneous coronary intervention: a prospective study.
abstract: BACKGROUND
  Retrospective studies based on clinical data and without spirometric confirmation suggest a poorer prognosis of patients with ischemic heart disease (IHD) and chronic obstructive pulmonary disease (COPD) following percutaneous coronary intervention (PCI). The impact of undiagnosed COPD in these patients is unknown. We aimed to evaluate the prognostic impact of COPD - previously or newly diagnosed - in patients with IHD treated with PCI.
  
  
  METHODS
  Patients with IHD confirmed by PCI were consecutively included. After PCI they underwent forced spirometry and evaluation for cardiovascular risk factors. All-cause mortality, new cardiovascular events, and their combined endpoint were analyzed.
  
  
  RESULTS
  A total of 133 patients (78%) male, with a mean (SD) age of 63 (10.12) years were included. Of these, 33 (24.8%) met the spirometric criteria for COPD, of whom 81.8% were undiagnosed. IHD patients with COPD were older, had more coronary vessels affected, and a greater history of previous myocardial infarction. Median follow-up was 934 days (interquartile range [25%-75%]: 546-1,160). COPD patients had greater mortality (P=0.008; hazard ratio [HR]: 8.85; 95% confidence interval [CI]: 1.76-44.47) and number of cardiovascular events (P=0.024; HR: 1.87; 95% CI: 1.04-3.33), even those without a previous diagnosis of COPD (P=0.01; HR: 1.78; 95% CI: 1.12-2.83). These differences remained after adjustment for sex, age, number of coronary vessels affected, and previous myocardial infarction (P=0.025; HR: 1.83; 95% CI: 1.08-3.1).
  
  
  CONCLUSIONS
  Prevalence and underdiagnosis of COPD in patients with IHD who undergo PCI are both high. These patients have an independent greater mortality and a higher number of cardiovascular events during follow-up.
authors.affiliation: Department of Internal Medicine, Mutua de Terrassa University Hospital, Terrassa, Spain.
authors.forename: Pere
authors.initials: P
authors.lastname: Almagro
authors.affiliation: Pneumology Service, Mutua de Terrassa University Hospital, Terrassa, Spain.
authors.forename: Anna
authors.initials: A
authors.lastname: Lapuente
authors.affiliation: Department of Internal Medicine, Mutua de Terrassa University Hospital, Terrassa, Spain.
authors.forename: Julia
authors.initials: J
authors.lastname: Pareja
authors.affiliation: Department of Internal Medicine, Mutua de Terrassa University Hospital, Terrassa, Spain.
authors.forename: Sergi
authors.initials: S
authors.lastname: Yun
authors.affiliation: Medical Department, Menarini Pharmaceutical, Barcelona, Spain.
authors.forename: Maria Estela
authors.initials: ME
authors.lastname: Garcia
authors.affiliation: Cardiology Service, Mutua de Terrassa University Hospital, Terrassa, Spain.
authors.forename: Ferrán
authors.initials: F
authors.lastname: Padilla
authors.affiliation: Pneumology Service, Mutua de Terrassa University Hospital, Terrassa, Spain.
authors.forename: Josep L I
authors.initials: JL
authors.lastname: Heredia
authors.affiliation: Department of Internal Medicine, Mutua de Terrassa University Hospital, Terrassa, Spain.
authors.forename: Alex
authors.initials: A
authors.lastname: De la Sierra
authors.affiliation: Instituto de Investigación Sanitaria Princesa (IP), Universidad Autónoma de Madrid, Madrid, Spain.
authors.forename: Joan B
authors.initials: JB
authors.lastname: Soriano
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008168:Lung / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000401:mortality; D011237:Predictive Value of Tests; D015995:Prevalence; D016016:Proportional Hazards Models; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D018570:Risk Assessment; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D013147:Spirometry; D013997:Time Factors; D016896:Treatment Outcome
keywords: ischemic heart disease; mortality; myocardial infarction; prognosis