title: Frequency of Cardiac Death and Stent Thrombosis in Patients With Chronic Obstructive Pulmonary Disease Undergoing Percutaneous Coronary Intervention (from the BASKET-PROVE I and II Trials).
abstract: Chronic obstructive pulmonary disease (COPD) is associated with long-term all-cause death after percutaneous coronary intervention with bare-metal stents. Regarding other outcomes, previous studies have shown conflicting results and the impact of drug-eluting stent (DES) in this population is not well known. We analyzed 4,605 patients who underwent percutaneous coronary intervention with bare-metal stents (33.1%) or DES (66.9%) from the Basel Stent Kosten-Effektivitats Trial-Prospective Validation Examination trials I and II. COPD patients (n = 283, 6.1%), were older and had more frequently a smoking or cardiovascular event history. At 2-year follow-up, cumulative event rates for patients with versus without COPD were the following: major adverse cardiac events (MACE: composite of cardiac death, nonfatal myocardial infarction, and target vessel revascularization): 15.2% versus 8.1% (p <0.001); all-cause death: 11.7% versus 2.4% (p <0.001); cardiac death: 5.7% versus 1.2% (p <0.001); myocardial infarction: 3.5% versus 1.9% (p = 0.045); definite/probable/possible stent thrombosis: 2.5% versus 0.9% (p = 0.01); and major bleeding: 4.2% versus 2.1% (p = 0.014). After adjusting for confounders including smoking status, COPD remained an independent predictor for MACE (hazard ratio [HR] 1.80, 95% confidence interval [CI] 1.31 to 2.49), all-cause death (HR 3.62, 95% CI 2.41 to 5.45), cardiac death (HR 3.12, 95% CI 1.74 to 5.60), and stent thrombosis (HR 2.39, 95% CI 1.03 to 5.54). We did not find evidence of an interaction between COPD and DES implantation (p for interaction = 0.29) for MACE. In conclusion, COPD is associated with increased 2-year rates of all-cause death, cardiac death, and stent thrombosis after stent implantation. DES use appears to be beneficial also in patients with COPD.
authors: Department of Interventional Cardiology, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts. Electronic address: tjatene@hotmail.com.
authors: Tannas
authors: T
authors: Jatene
authors: Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
authors: Tor
authors: T
authors: Biering-Sørensen
authors: Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Clinical Research, Innovation and Education Center, Tohoku University Hospital, Sendai, Japan.
authors: Kotaro
authors: K
authors: Nochioka
authors: Department of Interventional Cardiology, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts.
authors: Fernanda Marinho
authors: FM
authors: Mangione
authors: Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark.
authors: Kim Wadt
authors: KW
authors: Hansen
authors: Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
authors: Rikke
authors: R
authors: Sørensen
authors: Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
authors: Jan Skov
authors: JS
authors: Jensen
authors: Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
authors: Peter Godsk
authors: PG
authors: Jørgensen
authors: Department of Cardiology, University Hospital, Basel, Switzerland.
authors: Raban
authors: R
authors: Jeger
authors: Department of Cardiology, University Hospital, Basel, Switzerland.
authors: Christoph
authors: C
authors: Kaiser
authors: Department of Cardiology, University Hospital, Basel, Switzerland.
authors: Matthias
authors: M
authors: Pfisterer
authors: Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark.
authors: Søren
authors: S
authors: Galatius
mesh_terms: D000368:Aged; D002317:Cardiovascular Agents / Q000008:administration & dosage; D003327:Coronary Disease / Q000401:mortality* / Q000628:therapy*; D003328:Coronary Thrombosis / Q000209:etiology*; D054855:Drug-Eluting Stents / Q000009:adverse effects; D005260:Female; D006083:Graft Occlusion, Vascular / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications*; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents