Influence of chronic obstructive pulmonary disease on hospital outcomes of percutaneous coronary interventions in patients with acute coronary syndrome

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Abstract

Aim. To evaluate the impact of chronic obstructive pulmonary disease (COPD) on hospital outcomes of percutaneous coronary interventions (PCI) in patients with acute coronary syndrome (ACS).

Materials and methods. A cohort prospective study of the COPD effect on mortality and coronary microvascular obstruction (CMVO, no-reflow) development after PCI in ACS was carried out. 626 patients admitted in 2019–2020 were included, 418 (67%) – men, 208 (33%) – women. Median age – 63 [56; 70] years. Myocardial infarction with ST elevation identified in 308 patients (49%), CMVO – in 59 (9%) patients (criteria: blood flow <3 grade according to TIMI flow grade; perfusion <2 points according to Myocardial blush grade; ST segment resolution <70%). 13 (2.1%) patients died. Based on the questionnaire "Chronic Airways Diseases, A Guide for Primary Care Physicians, 2005", 2 groups of patients were identified: 197 (31%) with COPD (≥17 points) and 429 (69%) without COPD (<17 points). Groups were compared on unbalanced data (÷2 Pearson, Fisher exact test). The propensity score was calculated, and a two-way logistic regression analysis was performed. The data were balanced by the Kernel “weighting” method, logistic regression analysis was carried out using “weighting” coefficients. Results as odds ratio (OR) and 95% confidence interval.

Results. The conducted research allowed us to obtain the following results, depending on the type of analysis: 1) analysis of unbalanced data in patients with COPD: OR death 3.60 (1.16–11.12); p=0.03; OR CMVO 0.65 (0.35–1.22); p=0,18; 2) two-way analysis with propensity score: OR death 3.86 (1.09–13.74); p=0.04; OR CMVO 0.61 (0.31–1.19); p=0.15; 3) regression analysis with "weight" coefficients: OR death 12.49 (2.27–68.84); p=0.004; OR CMVO 0.63 (0.30–1.33); p=0.22.

Conclusion. The presence of COPD in patients with ACS undergoing PCI increases mortality and does not affect the incidence of CMVO.

About the authors

Alexey A. Frolov

Privolzhsky Research Medical University; City Clinical Hospital No. 13 of the Nizhny Novgorod Avtozavodsky District

Email: frolov-al-al@yandex.ru
ORCID iD: 0000-0001-7228-7563

канд. мед. наук, ассистент каф. госпитальной хирургии им. Б.А. Королева ФГБОУ ВО ПИМУ, врач отд-ния рентгенохирургических методов диагностики и лечения ГБУЗ НО «ГКБ №13 Автозаводского района г. Нижнего Новгорода»

Russian Federation, Nizhny Novgorod; Nizhny Novgorod

Vasily D. Fedotov

Privolzhsky Research Medical University; Nizhny Novgorod Scientific Research Institute of Hygiene and Occupational Diseases

Author for correspondence.
Email: basil11@yandex.ru
ORCID iD: 0000-0003-4307-9321

канд. мед. наук, доц. каф. госпитальной терапии и общей врачебной практики им. В.Г. Вогралика ФГБОУ ВО ПИМУ, ст. науч. сотр. клинического отд. ФБУН ННИИГП

Russian Federation, Nizhny Novgorod; Nizhny Novgorod

Igor A. Frolov

City Clinical Hospital No. 13 of the Nizhny Novgorod Avtozavodsky District

Email: dr.iafrolov@gmail.com
ORCID iD: 0000-0003-2955-304X

врач отд-ния рентгенохирургических методов диагностики и лечения, ГБУЗ НО «ГКБ №13 Автозаводского района г. Нижнего Новгорода»

Russian Federation, Nizhny Novgorod

Ilya G. Pochinka

Privolzhsky Research Medical University; City Clinical Hospital No. 13 of the Nizhny Novgorod Avtozavodsky District

Email: pochinka4@yandex.ru
ORCID iD: 0000-0001-5709-0703

д-р мед. наук, доц., зав. каф. эндокринологии и внутренних болезней ФГБОУ ВО ПИМУ, зав. кардиологическим отд-нием ГБУЗ НО «ГКБ №13 Автозаводского района г. Нижнего Новгорода»

Russian Federation, Nizhny Novgorod; Nizhny Novgorod

Natalia V. Protasova

City Clinical Hospital No. 13 of the Nizhny Novgorod Avtozavodsky District

Email: protasova.n1962@gmail.com
ORCID iD: 0000-0003-2099-8325

врач отд-ния рентгенохирургических методов диагностики и лечения ГБУЗ НО «ГКБ №13 Автозаводского района г. Нижнего Новгорода»

Russian Federation, Nizhny Novgorod

Galina N. Kouzova

City Clinical Hospital No. 13 of the Nizhny Novgorod Avtozavodsky District

Email: Koyzovagalina42@gmail.com
ORCID iD: 0000-0001-5848-6216

врач отд-ния рентгенохирургических методов диагностики и лечения ГБУЗ НО «ГКБ №13 Автозаводского района г. Нижнего Новгорода»

Russian Federation, Nizhny Novgorod

Aleksey S. Mukhin

Privolzhsky Research Medical University

Email: prof.mukhin@mail.ru
ORCID iD: 0000-0003-2336-8900

д-р мед. наук, проф., зав. каф. госпитальной хирургии им. Б.А. Королева ФГБОУ ВО ПИМУ

Russian Federation, Nizhny Novgorod

Kirill V. Kuzmichev

Privolzhsky Research Medical University; City Clinical Hospital No. 13 of the Nizhny Novgorod Avtozavodsky District

Email: kir2010k@yandex.ru
ORCID iD: 0000-0002-1513-0313

ассистент каф. эндокринологии и внутренних болезней ФГБОУ ВО ПИМУ, врач приемного отд-ния ГБУЗ НО «ГКБ №13 Автозаводского района г. Нижнего Новгорода»

Russian Federation, Nizhny Novgorod; Nizhny Novgorod

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Supplementary files

Supplementary Files
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1. JATS XML
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2. Fig. 1. Study flowchart.

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3. Fig. 2. Histogram of the propensity score distribution between the studied groups.

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4. Fig. 3. The result of balancing indicators between comparison groups.

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5. Fig. 4. Results of logistic regression analysis using "weight" coefficients in relation to the outcome "hospital mortality".

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6. Fig. 5. Results of logistic regression analysis using "weight" coefficients in relation to the outcome "Coronary microvascular obstruction".

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