Predictors of repeat myocardial revascularization for the long-term after percutaneous coronary interventions in patients with combination of coronary artery disease and chronic obstructive pulmonary disease

Abstract

Aim. To assess the influence of concomitant chronic obstructive pulmonary disease (COPD) on the frequency of repeat myocardial revascularization in patients with coronary artery disease (CAD) after percutaneous coronary interventions (PCI), as well as to determine independent predictors of repeat revascularization in patients with concominant COPD. Materials and methods. A prospective cohort study included 646 patients with CAD, of which 254 had concominant COPD. All patients underwent PCI (46.9% for acute coronary syndrome in the main group and 44.9% in the control group. Remaining interventions were elective). The frequency of repeat myocardial revascularization and the time till re-intervention was registered during the follow-up period up to 36 months. Results. COPD increases risk of repeat myocardial revascularization (hazard ratio - HR 1.46; 95% confidence interval - CI 1.03-2.06), repeat PCI (HR 1.62; 95% CI 1.03-2.32) and is accompanied by an earlier onset of re-intervention. An independent predictors of repeat myocardial revascularization in the Cox regression model are: glomerular filtration rate (p=0.001), ankle-brachial index (p=0.004), frequent exacerbations of COPD (p=0.028), total number of coronary artery stenosis (p=0.039) and blood concentration of C-reactive protein (p=0.066). Conclusions. COPD is a significant risk factor of re-intervention after PCI in patients with acute and chronic forms of CAD and leads to its earlier performing. The patients with frequent COPD exacerbations have the highest risk of repeat myocardial revascularization during follow-up.

Keywords

• coronary artery disease
• repeated myocardial revascularization
• chronic obstructive pulmonary disease
• predictors