Association between chronic obstructive pulmonary disease and in-hospital mortality after percutaneous coronary intervention: a retrospective cohort study in Germany

Abstract

Chronic obstructive pulmonary disease (COPD) is one of the leading chronic diseases worldwide. However, the impact of COPD on outcome after percutaneous coronary intervention (PCI) remains unclear. In this retrospective cohort study, we analyzed the data of hospitalized patients undergoing PCI in Germany between 2015 and 2019. We compared in-hospital mortality, hospital length of stay and peri-interventional ventilation time (VT) in patients with and without COPD, including different COPD severity grades, COPD with exacerbation (COPD_e) and infection (COPD_i). We analyzed the data of 3,464,369 cases undergoing PCI. A total of 291,707 patients (8.4%) suffered from COPD. Patients suffering from COPD died more often (2.4% vs. 2.0%; p < 0.001), stayed longer hospitalized (5 days (2-10) vs. 3 days (1-6); p < 0.001), were more frequent (7.2% vs. 3.2%) and longer ventilated (26 h (7-88) vs. 23 h (5-92); p < 0.001). Surprisingly, COPD was associated with a 0.78-fold odds of in-hospital mortality and with reduced VT (- 1.94 h, 95% CI, - 4.34 to 0.43). Mild to severe COPD was associated with a lower risk of in-hospital mortality and reduced VT, whereas very severe COPD, COPD_e and COPD_i showed a higher risk of in-hospital mortality. We found a paradoxical association between mild to severe COPD and in-hospital mortality, whereas very severe COPD, COPD_e and COPD_i were associated with higher in-hospital mortality. Further investigations should illuminate, whether comorbidities affect these associations.

Keywords: Chronic obstructive pulmonary disease; In-hospital mortality; Percutaneous coronary intervention.

Figure 1

Flow chart of patient inclusion. Flow chart of patient inclusion of a population-based retrospective analysis investigating the impact of COPD and COPD severity on in-hospital mortality, hospital length of stay (HLOS) and ventilation time (VT) in 3,464,369 cases undergoing PCI.