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) (original) (raw)

Abstract

Chronic obstructive pulmonary disease (COPD) is associated with long-term all-cause death following percutaneous coronary intervention (PCI) with bare-metal stents (BMS). 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 4605 patients that underwent PCI with BMS (33.1%) or DES (66.9%) from the BASKET-PROVE 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, non-fatal myocardial infarction and target vessel revascularization]: 15.2 vs. 8.1% (p<0.001); all-cause death: 11.7 vs. 2.4%, (p<0.001); cardiac death: 5.7 vs. 1.2%, (p<0.001); myocardial infarction: 3.5 vs. 1.9% (p=0.045); definite/probable/possible stent thrombosis: 2.5 vs. 0.9% (p=0.01); and major bleeding: 4.2 vs. 2.1% (p=0.014). After adjusting for confounders including smoking status, COPD remained an independent predictor for MACE (HR 1.80, 95%CI 1.31-2.49), allcause death (HR 3.62, 95%CI 2.41-5.45), cardiac death (HR 3.12, 95%CI 1.74-5.60) and stent thrombosis (HR 2.39, 95% CI 1.03-5.54). 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 COPD patients.

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