Sep 062011

Enriquez et al analyzed data from the NHLBI Dynamic Registry, comparing 860 people with COPD to 10,048 without who underwent percutaneous coronary intervention between 1999-2006. Their main findings: COPD patients were sicker and had worse outcomes. Demographically, they had a higher rate of diabetes, slightly more lesions (3.2 vs. 3.0), and slightly lower ejection fractions. Only half were prescribed beta blockers at discharge (compared to 76% of non-COPDers). After attempted adjustment for confounders, people with COPD had a one-year hazard ratio of death of 1.30 and of revascularization, 1.22 (significant).

Given the a priori knowledge that people with COPD are probably sicker than those without; the differences at baseline between groups (COPD group had more men, and were 3+ years older); referral biases; possible misdiagnosis of CHF as COPD (suggested by the lower ejection fraction in the COPD cohort); and changes in CAD therapies since 1999, it's hard to know what to conclude from this, if anything. Probably we should be giving more beta blockers to COPD patients after PCI (2011 BMJ database review, and a 2005 Cochrane analysis suggest it's safe and beneficial).

Enriquez JR et al. Increased Adverse Events After Percutaneous Coronary Intervention in Patients With COPD: Insights From the National Heart, Lung, and Blood Institute Dynamic Registry. CHEST 2011;140:604-610.

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People with COPD at higher risk for bad outcomes 1 year after stenting for CAD