Invasive coronary angiography in patients with acute exacerbated COPD and elevated plasma troponin

Figures & data

Table 1 Demographic, clinical, and echocardiographic characteristics of total study population at the time of hospitalization for acute exacerbated COPD

All patients, n	88
Age, years	72.9±9.2
Male sex, n (%)	50 (56.8)
COPD staging, n (%)a
GOLD A	13 (14.8)
GOLD B	29 (32.9)
GOLD C	19 (21.6)
GOLD D	27 (30.7)
Cardiovascular risk factors, n (%)b
Diabetes mellitus	30 (34.1)
Arterial hypertension	70 (79.5)
Hyperlipidemia	34 (38.6)
Familial disposition	19 (21.6)
Obesity	32 (36.4)
Smoking status, n (%)
Current smoker	53 (60.2)
Former smoker	33 (37.5)
Never smoker	2 (2.3)
Pack-years	40.0 (0–100)
Antiobstructive/antiinflammatory medication use at admission, n (%)
Long-term oxygen therapy	3 (3.4)
Long-acting beta2 agonist	65 (73.9)
Long-acting anticholinergic	63 (71.6)
Inhaled glucocorticoids	42 (47.7)
Systemic glucocorticoids	13 (14.8)
PDE-4 inhibitor (roflumilast)	6 (6.8)
Cardiovascular medication use at admission, n (%)
Platelet inhibitor	19 (21.6)
Statin	14 (15.9)
ACE inhibitor	33 (37.5)
Angiotensin II receptor blocker	16 (18.2)
Beta-blocker	39 (44.3)
Calcium channel blocker	20 (22.7)
Diuretics	51 (58.0)
Echocardiographic parameters
LV ejection fraction, %	51.9±13.9
Diastolic LV dysfunction, n (%)
No diastolic LV dysfunction	49 (55.7)
Grade I	27 (30.7)
Grade II	6 (6.8)
Grade III	6 (6.8)
PASP, mmHg	40.0±12.2
PASP, n (%)
<30 mmHg	58 (65.9)
30 mmHg to <50 mmHg	21 (23.9)
50 mmHg to <70 mmHg	7 (7.9)
≥70 mmHg	2 (2.3)
Wall motion abnormalities, n (%)	26 (29.5)

Notes: Data are presented as total number and percentage (in parentheses), mean ± SD or median and range (in parentheses).

a COPD staging is based on the pulmonary function testing results obtained in the last exacerbation-free period, as assessed by collection from the patient’s medical reports.

b Cardiovascular risk factors were recorded as self-reported by patients at hospital admission.

Abbreviations: GOLD, Global Initiative for Chronic Obstructive Lung Disease; PDE-4, phosphodiesterase-4; ACE, angiotensin-converting enzyme; LV, left ventricular; PASP, pulmonary arterial systolic pressure; SD, standard deviation.

Figure 1 Coronary artery angiography of a 71-year old male with acute exacerbated COPD GOLD D and elevated plasma troponin.

Notes: (A) Initial angiogram revealed single-vessel coronary artery disease with critical stenosis of mid-right coronary artery (90%) (full-line arrow). The stenosis was treated by insertion of a drug-eluting stent (diameter: 3.5 mm; length: 18.0 mm). Part (B) illustrates the satisfactory final angiographic result immediately after stent implantation.

Table 2 Comparison of laboratory and pulmonary parameters as a function of angiographically evidenced indication for percutaneous coronary intervention

Categorical variables	Patients with indication for percutaneous coronary intervention (n=34)	Patients without indication for percutaneous coronary intervention (n=54)	P-value
Age, years	73.3±9.1	72.8±9.4	0.89
Male sex, n (%)	19 (55.9)	31 (57.4)	0.8
Laboratory parameters at admission
Cardiac troponin I, ng/mL	2.66±6.49	1.48±3.60	0.28
CRP, mg/L	57.4±76.6	49.7±60.8	0.62
D-Dimer, mg/L	2.53±2.53	1.72±1.44	0.24
Leukocytes, 10^9/mL	11.9±3.8	12.9±7.8	0.48
Neutrophils, % of leukocyte count	82.0±11.1	76.7±16.3	0.14
Hemoglobin, g/dL	13.0±2.1	13.2±1.8	0.58
Thrombocytes, 10^9/mL	258.7±99.9	225.6±83.9	0.09
Serum creatinine concentration, mg/dL	1.33±0.85	1.33±0.58	1
Glomerular filtration rate, mL/min	55.6±16.1	53.2±16.7	0.52
CK, U/L	170.1±139.6	247.4±325.9	0.21
CK-MB, µg/L	11.3±18.8	8.7±22.2	0.49
Total cholesterol, mg/dL	169.8±56.9	161.9±33.3	0.56
LDL cholesterol, mg/dL	113.5±55.4	93.4±32.0	0.04
HDL cholesterol, mg/dL	53.2±24.6	53.9±23.1	0.89
Triglycerides, mg/dL	127.5±65.2	115.2±85.1	0.48
Glucose, mg/dL	173.0±74.9	136.7±49.7	<0.01
Pack-years	53.9±24.4	38.7±33.2	0.16
Pulmonary function parametersa
FEV1, L	1.07±0.59	1.11±0.49	0.86
FEV1, % predicted	41.8±16.9	45.4±17.2	0.61
RV, L	4.08±1.04	4.05±1.41	0.95
RV, % predicted	168.9±64.0	174.4±65.5	0.86
Forced vital capacity, L	1.92±0.74	1.73±0.72	0.56
Forced vital capacity, % predicted	55.7±14.7	52.4±14.5	0.62

Notes: Data are shown as total number and percentage (in parentheses) or mean ± SD.

a Obtained during hospitalization by postbronchodilator spirometry and body plethysmography. Statistical analyses were performed by use of Student’s t-test or Mann–Whitney U-test, in the case of continuous parameters. Categorical variables were analyzed for association using Pearson’s χ² test. Statistical significance was assumed when the null hypothesis could be rejected at P<0.05.

Abbreviations: CRP, C-reactive protein; CK, creatine kinase; CK-MB, creatine kinase-myocardial band; LDL, low-density lipoprotein; HDL, high-density lipoprotein; FEV₁, forced expiratory volume in 1 second; RV, residual volume.

Table 3 Data comparison of noninvasive cardiological and angiological testing as a function of angiographically evidenced indication for percutaneous coronary intervention

Categorical variables	Patients with indication for percutaneous coronary intervention (n=34)	Patients without indication for percutaneous coronary intervention (n=54)	P-value
Cardiovascular risk factors, n (%)a
Diabetes mellitus	11 (32.4)	19 (35.2)	0.78
Arterial hypertension	27 (79.4)	43 (79.6)	0.61
Hyperlipidemia	15 (44.1)	19 (35.2)	0.21
Familial disposition	7 (20.6)	12 (22.2)	0.51
Obesity	11 (32.4)	21 (38.9)	0.43
Echocardiographic parameters
LV ejection fraction, %	45.8±13.1	55.1±13.3	0.01
Diastolic LV dysfunction, n (%)
No diastolic LV dysfunction	16 (47.0)	33 (61.1)	0.41
Grade I	12 (35.3)	15 (27.8)
Grade II	2 (5.9)	4 (7.4)
Grade III	4 (11.8)	2 (3.7)
PASP, mmHg	39.5±9.7	40.3±13.9	0.85
Wall motion abnormalities, n (%)	9 (26.5)	17 (31.5)	0.80
Electrocardiographic changes, n (%)
Rhythm
Sinus rhythm	30 (88.2)	41 (75.9)	0.21
Atrial fibrillation	2 (5.9)	8 (14.8)
Atrial flutter	0 (0)	1 (1.9)
Paced rhythm	2 (5.9)	4 (7.4)
Heart rate
Bradycardia	1 (2.9)	2 (3.7)	0.06
Tachycardia	11 (32.3)	11 (20.4)
ST-segment depression	7 (20.6)	4 (7.4)	0.01
T wave inversion	7 (20.6)	15 (27.8)	0.62
Premature beats
Atrial	5 (14.7)	5 (9.3)	0.42
Ventricular	1 (2.9)	2 (3.7)	0.79
Angiological testing
ABI
Right posterior tibial artery	0.84±0.23	1.08±0.39	0.13
Left posterior tibial artery	0.75±0.29	1.19±0.31	<0.01
PWI
Right PWI	577.5 (128–1,000)	290 (134–1,000)	0.64
Left PWI	500.5 (102–694)	213 (139–705)	0.34
Central pulse wave velocity, m/s	8.2 (2.5–18.2)	6.7 (4.6–10.3)	0.52

Notes: Data are presented as total number and percentage (in parentheses), mean ± SD or median and range (in parentheses).

a Cardiovascular risk factors were recorded as self-reported by patients at hospital admission. Statistical analyses were performed by use of Student’s t-test or Mann–Whitney U-test, in the case of continuous parameters. Categorical variables were analyzed for association using Pearson’s χ² test. Statistical significance was assumed when the null hypothesis could be rejected at P<0.05.

Abbreviations: LV, left ventricular; PASP, pulmonary arterial systolic pressure; ABI, ankle brachial index; PWI, pulse wave index; SD, standard deviation.