Prediction of long-term adverse cardiovascular events after percutaneous coronary interventions in patients with coronary artery disease and concomitant chronic obstructive pulmonary disease

Abstract

Aim To identify independent predictors for long-term serious adverse cardiovascular events following percutaneous coronary interventions (PCI) in patients with a combination of ischemic heart disease (IHD) and chronic obstructive pulmonary disease (COPD) and to develop a prognostic mathematical model.Materials and methods Design: a prospective cohort study. The study included 254 patients with IHD associated with COPD after PCI (in 119 patients, PCI was performed for acute coronary syndrome and in 135 patients, PCI was elective). Follow-up duration was up to 36 months. Composite endpoint included cardiovascular death, myocardial infarction, stroke or repeated, unscheduled myocardial revascularization. Cox regression with stepwise inclusion of variables was used for identification of predictors for the composite endpoint.Results The following independent predictors of serious adverse cardiovascular events were identified: number of stenoses in major coronary artery branches, ankle-brachial index. glomerular filtration rate, age, distance in 6-min walk test, COPD phenotype with frequent exacerbations (FE), and functional residual capacity (FRC) of lungs. The mathematical model based on the Cox regression for prediction of serious adverse cardiovascular events had a 75% sensitivity and a 81% specificity.Conclusion Incidence of long-term serious adverse cardiovascular events in patients with a combination of IHD and COPD after PCI depends not only on traditional cardiovascular risk factors but also on characteristics of COPD itself, such as the FE phenotype and the FRC indicative of lung hyperinflation. The proposed mathematical model based on the Cox regression can be used for evaluating the odds for adverse cardiovascular events after PCI in patients with a combination of IHD and COPD.