Invasive coronary angiography in patients with acute exacerbated COPD and elevated plasma troponin.
BACKGROUND
In acute exacerbation of COPD, increased plasma levels of cardiac troponin are frequent and associated with increased mortality. Thus, we aimed at prospectively determining the diagnostic value of coronary angiography in patients with exacerbated COPD and concomitantly elevated cardiac troponin.


METHODS
A total of 88 patients (mean age 72.9±9.2 years, 56.8% male) hospitalized for acute exacerbation of COPD with elevated plasma troponin were included. All patients underwent coronary angiography within 72 hours after hospitalization. Complementary 12-lead electrocardiogram, transthoracic echocardiography, pulmonary function, and angiological testing were performed.


RESULTS
Coronary angiography objectified the presence of ischemic heart disease (IHD) in 59 patients (67.0%), of whom 34 patients (38.6% of total study population) underwent percutaneous coronary intervention. Among these 34 intervened patients, the vast majority (n=26, 76.5%) had no previously known IHD, whereas only eight out of 34 patients (23.5%) presented an IHD history. Patients requiring coronary intervention showed significantly reduced left ventricular ejection fraction (45.8%±13.1% vs 55.1%±13.3%,P=0.01) and a significantly more frequent electrocardiographic ST-segment depression (20.6% vs 7.4%,P=0.01). Neither additional laboratory parameters for inflammation and myocardial injury nor lung functional measurements differed significantly between the groups.


CONCLUSIONS
Angiographically confirmed IHD that required revascularization occurred in 38.6% of exacerbated COPD patients with elevated cardiac troponin. In this considerable portion of patients, coronary angiography emerged to be of diagnostic and therapeutic value.
Department of Internal Medicine II - Cardiology, Pneumology and Angiology, University Hospital Bonn, Bonn, Germany.
Carmen
C
Pizarro
Department of Internal Medicine II - Cardiology, Pneumology and Angiology, University Hospital Bonn, Bonn, Germany.
Neele
N
Herweg-Steffens
Department of Pneumology, Johanniter Hospital Bonn, Bonn, Germany.
Martin
M
Buchenroth
Department of Pneumology, Malteser Hospital Bonn/Rhein-Sieg, Bonn, Germany.
Wolfgang
W
Schulte
Department of Internal Medicine II - Cardiology, Pneumology and Angiology, University Hospital Bonn, Bonn, Germany.
Christian
C
Schaefer
Department of Internal Medicine II - Cardiology, Pneumology and Angiology, University Hospital Bonn, Bonn, Germany.
Christoph
C
Hammerstingl
Department of Internal Medicine II - Cardiology, Pneumology and Angiology, University Hospital Bonn, Bonn, Germany.
Nikos
N
Werner
Department of Internal Medicine II - Cardiology, Pneumology and Angiology, University Hospital Bonn, Bonn, Germany.
Georg
G
Nickenig
Department of Internal Medicine II - Cardiology, Pneumology and Angiology, University Hospital Bonn, Bonn, Germany.
Dirk
D
Skowasch
D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy; D023921:Coronary Stenosis / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy; D018450:Disease Progression; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005541:Forced Expiratory Volume; D005858:Germany; D006760:Hospitalization; D006801:Humans; D008168:Lung / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D010993:Plethysmography, Whole Body; D011237:Predictive Value of Tests; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D012720:Severity of Illness Index; D013147:Spirometry; D019210:Troponin I / Q000097:blood*; D015854:Up-Regulation
D015415:Biomarkers; D019210:Troponin I
COPD; acute exacerbation; coronary angiography; ischemic heart disease; troponin elevation
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