Chronic obstructive pulmonary disease as a prognostic factor for patients with coronary heart disease

F Noack; F Höpfner; B Schmidt; K Werdan; C Ulrich; B Hofmann; A Schlitt

doi:10.1055/s-0032-1302593

Pneumologie, Table of Contents

Chronic obstructive pulmonary disease as a prognostic factor for patients with coronary heart disease

F Noack ¹, F Höpfner ², B Schmidt ¹, K Werdan ², C Ulrich ³, B Hofmann ⁴, A Schlitt ²

¹Universitätsklinikum Halle, Universitätsklinik und Poliklinik für Innere Medizin I, Schwerpunkt Pneumologie
²Universitätsklinikum Halle, Universitätsklinik und Poliklinik für Innere Medizin III
³Universitätsklinikum Halle, Universitätsklinik und Poliklinik für Innere Medizin II
⁴Universitätsklinikum Halle, Universitätsklinik und Poliklinik für Herz- und Thoraxchirurgie

Abstract

Introduction: Previous studies have demonstrated that chronic obstructive pulmonary disease (COPD) increases mortality in patients with coronary heart disease (CHD).

Methods: 1,014 patients with angiographically proven CHD were included in the prospective PHAMOS trial (see ClinicalTrials.gov) during their hospital stay in the departments of internal medicine and the department for cardiothoracic surgery of the Martin Luther-University Halle (Germany). Patients with known COPD or newly diagnosed COPD (n=105) were compared to patients without COPD (n=891). Patients with asthma (n=18) were excluded. Primary endpoint was all cause death. Univariate outcome analysis was performed by Kaplan-Meier analysis with log-rank test. Multivariate analysis was performed by Cox regression analyses.

Results: Patients with COPD were significantly older (70.9±9.4 vs. 67.7±10.1 years of age, p=0.002). All other classical cardiovascular risk factors including gender, BMI, arterial hypertension, diabetes mellitus, hyperlipoproteinemia and family history of CHD were not significantly different between the two groups. In the mean follow-up of 1.3±0.6 years 131 patients died. Mortality was significantly increased in COPD patients after univariate Kaplan-Meier analysis (24.0% COPD vs. 11.9%, p=0.003). In multivariate Cox regression analysis including the risk factors COPD lost its predictive value (95% CI 0.973–2.430, p=0.065).

Conclusion: The presence of COPD was a prognostic factor in the survival of patients with CHD undergoing univariate analysis. However, after controlling for other variables by multivariate analysis, COPD lost its prognostic value. These results contradict previous findings where COPD was an independent risk factor for patients with CHD. We hypothesize that any weakening in the interaction between COPD and CHD (observed between previous and the present studies) may be due to modern treatment strategies for each condition reducing the adverse impact of the disease process.