Lung Hyperinflation in Chronic Obstructive Pulmonary Disease and Long-Term Outcomes of Percutaneous Coronary Intervention

Objective: to assess the effect of lung hyperinflation (LHI) in patients with chronic obstructive pulmonary disease (COPD) on longterm outcomes of percutaneous coronary intervention (PCI). Materials and methods. Patients with COPD who suffered stable ischemic heart disease and underwent PCI (n=135) were included in a prospective cohort study. LHI was found in 60 patients, while 75 patients had no LHI. Evaluation included comparing the frequency of major adverse cardiac events (MACE) (cardiac death, myocardial infarction [MI], stroke, repeat revascularization) and Kaplan-Mayer curves between groups of patients with and without LHI. Associations of parameters of pulmonary function and plasma levels of high sensitivity C-reactive protein (hsCRP) with occurrence of MACE were also elucidated. Duration of follow-up was up to 3 years (median 20 months). Results. Study groups did not differ significantly by main factors of cardiovascular risk, except plasma level of hsCRP. MACE occurred in 41.7 and 26.7% of patients in groups with and without LHI, respectively (p=0.097). However, divergence of the Kaplan-Meier curves was statistically significant (p=0.04). The main contribution was made by cardiac death, MI and stroke (21.7 and 8.0% among patients with and without LHI; p=0.027). No difference was found regarding repeat revascularization. The correlation between functional residual lung capacity and plasma level of hsCRP was closer than the correlation between forced expiratory volume in 1 second and hsCRP level (r=0.36 and r=0.19; p<0.05). Conclusion. After elective PCI in patients with COPD the presence of LHI increased risk of cardiovascular events (cardiac death, myocardial infarction and stroke) by 2.7 times (95% confidence interval 1.1-6.7). LHI produced no effect on repeat elective PCI.

легочная гиперинфляция, ишемическая болезнь сердца, чрескожное коронарное вмешательство, хроническая обструктивная болезнь легких, lung hyperinflation, ischemic heart disease, chronic obstructive pulmonary disease

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