Time trends in coronary revascularization procedures among people with COPD: analysis of the Spanish national hospital discharge data (2001–2011)

Figures & data

Figure 1 Joinpoint analyses.

Notes: Joinpoint analysis in annual PCI in patients with (A) and without (B) COPD in Spain, from 2001 to 2011. Joinpoint analysis in annual CABG in patients with (C) and without (D) COPD in Spain, from 2001 to 2011. Annual percent change (APC) (based on rates that were sex and age-adjusted using the Spanish National Statistics Institute Census projections) calculated by using joinpoint regression analysis. APC is significantly different from zero (two-sided P<0.05).
Abbreviation: PCI, percutaneous coronary intervention.

Table 1 Characteristics and outcomes of hospital discharges after percutaneous coronary intervention among patients with and without COPD in Spain, from 2001 to 2011

	2001	2002	2003	2004	2005	2006	2007	2008	2009	2010	2011	P-value
No COPD
N	18,960	22,737	26,703	30,811	35,774	38,212	41,636	44,289	46,394	46,067	47,303	0.000
Incidence	97.48	115.63	133.04	150.34	171.01	178.78	190.86	199.02	204.97	200.7	203.11
Age, mean (SD)	63.75 (10.74)	64 (10.93)	63.93 (11)	64.37 (11.05)	64.75 (11.06)	65.03 (11.21)	65.22 (11.36)	65.49 (11.51)	65.47 (11.6)	65.51 (11.71)	65.69 (11.77)	0.000
Male, n (%)	14,578 (76.89)	17,405 (76.55)	20,454 (76.6)	23,386 (75.9)	27,005 (75.49)	28,762 (75.27)	31,326 (75.24)	33,206 (74.98)	34,931 (75.29)	34,729 (75.39)	35,562 (75.18)	0.000
CCI 0,a n (%)	12,443 (65.63)	14,145 (62.21)	16,011 (59.96)	18,079 (58.68)	20,476 (57.24)	21,654 (56.67)	23,046 (55.35)	24,167 (54.57)	24,925 (53.72)	24,505 (53.19)	24,913 (52.67)	0.000
CCI 1–2a, n (%)	6,314 (33.3)	8,278 (36.41)	10,241 (38.35)	12,204 (39.61)	14,537 (40.64)	15,814 (41.38)	17,603 (42.28)	18,888 (42.65)	20,034 (43.18)	20,027 (43.47)	20,769 (43.91)
CCI ≥3a, n (%)	203 (1.07)	314 (1.38)	451 (1.69)	528 (1.71)	761 (2.13)	744 (1.95)	987 (2.37)	1,234 (2.79)	1,435 (3.09)	1,535 (3.33)	1,621 (3.43)
LOS, median (IQR)	6 (9)	6 (9)	6 (8)	6 (8)	6 (8)	6 (7)	6 (7)	5 (7)	5 (7)	5 (6)	5 (6)	0.000
IHM, n (%)	368 (1.94)	426 (1.87)	522 (1.95)	577 (1.87)	728 (2.03)	743 (1.94)	849 (2.04)	973 (2.2)	1,051 (2.27)	1,069 (2.32)	1,143 (2.42)	0.000
COPD
N	1,265	1,569	1,945	2,290	2,647	2,689	3,044	3,260	3,526	3,611	3,784	0.000
Incidence	6.43	7.88	9.59	11.07	12.55	12.46	13.83	14.57	15.54	15.71	16.25
Age, mean (SD)	68.43 (8.95)	68.7 (9.1)	68.7 (9.22)	68.8 (9.32)	69.4 (9.54)	69.8 (9.22)	69.91 (9.52)	70.11 (9.58)	70.16 (9.76)	70.55 (9.76)	70.61 (9.85)	0.000
Male, n (%)	1,203 (95.1)	1,480 (94.33)	1,803 (92.7)	2,130 (93.01)	2,477 (93.58)	2,490 (92.6)	2,817 (92.54)	3,019 (92.61)	3,259 (92.43)	3,342 (92.55)	3,483 (92.05)	0.011
CCI 0,a n (%)	671 (53.04)	850 (54.17)	928 (47.71)	1,050 (45.85)	1,233 (46.58)	1,174 (43.66)	1,335 (43.86)	1,310 (40.18)	1,405 (39.85)	1,414 (39.16)	1,434 (37.9)	0.000
CCI 1–2a, n (%)	564 (44.58)	669 (42.64)	949 (48.79)	1,143 (49.91)	1,302 (49.19)	1,396 (51.92)	1,556 (51.12)	1,746 (53.56)	1,936 (54.91)	1,979 (54.8)	2,109 (55.73)
CCI ≥3a, n (%)	30 (2.37)	50 (3.19)	68 (3.5)	97 (4.24)	112 (4.23)	119 (4.43)	153 (5.03)	204 (6.26)	185 (5.25)	218 (6.04)	241 (6.37)
LOS, median (IQR)	9 (10)	8 (9)	8 (10)	8 (9)	8 (9)	7 (8)	7 (8)	7 (8)	7 (7)	7 (7)	6 (6)	0.000
IHM, n (%)	30 (2.37)	40 (2.55)	60 (3.08)	77 (3.36)	81 (3.06)	77 (2.86)	67 (2.2)	117 (3.59)	132 (3.74)	92 (2.55)	107 (2.83)	0.007

Notes:

a CCI (Charlson comorbidity index): comorbidities included in the CCI, except COPD and AMI. Incidence per 100,000. Incidence was calculated using the Spanish National Statistics Institute census projections, adjusted by sex and age.²¹

Abbreviations: AMI, acute myocardial infarction; n, number of procedures; IHM, in-hospital mortality; LOS, length of stay; SD, standard deviation; IQR, interquartile range.

Table 2 Multivariate analysis of the factors associated with in-hospital mortality after coronary revascularization procedures among patients with and without COPD in Spain, from 2001 to 2011

	In-hospital mortality (OR)a COPD		In-hospital mortality (OR)a No COPD		In-hospital mortality (OR)a All
	PCI	CABG	PCI	CABG	PCI	CABG
Age (years)
40–59	1	1	1	1	1	1
60–69	2.00 (1.46–2.73)	1.77 (1.21–2.60)	1.42 (1.32–1.53)	1.51 (1.37–1.67)	1.46 (1.36–1.57)	1.52 (1.39–1.68)
70–79	2.82 (2.10–3.78)	3.22 (2.25–4.60)	2.42 (2.26–2.59)	2.54 (2.32–2.79)	2.45 (2.30–2.61)	2.59 (2.37–2.83)
≥80	4.29 (3.14–5.84)	5.84 (3.76–9.06)	4.40 (4.08–4.73)	3.87 (3.42–4.39)	4.37 (4.07–4.70)	4.00 (3.55–4.51)
Sex
Male	1	1	1	1	1	1
Female	0.87 (0.66–1.14)	1.32 (0.96–1.80)	1.21 (1.15–1.27)	1.39 (1.30–1.48)	1.19 (1.14–1.25)	1.38 (1.30–1.47)
Charlson index
0	1	1	1	1	1	1
1–2	1.93 (1.65–2.26)	1.47 (1.21–1.78)	2.31 (2.20–2.42)	1.67 (1.57–1.78)	2.28 (2.18–2.39)	1.65 (1.56–1.75)
≥3	3.26 (2.54–4.18)	2.58 (1.78–3.72)	5.56 (5.11–6.05)	3.60 (3.17–4.08)	5.25 (4.85–5.70)	3.48 (3.08–3.92)
COPD
No	NA	NA	NA	NA	1	1
Yes	NA	NA	NA	NA	1.11 (1.03–1.20)	1.06 (0.96–1.17)
Year	0.98 (0.96–1.00)	0.93 (0.90–0.96)	0.99 (0.99–1.01)	0.94 (0.93–0.95)	0.99 (0.99–1.00)	0.94 (0.93–0.95)

Notes:

a Calculated using logistic regression models: odds ratio (OR). The logistic regression multivariate model was built using “death (yes/no)” as dependent variables and year, sex, Charlson comorbidity index, and age as independent variables.

Abbreviations: CABG, coronary artery bypass graft; PCI, percutaneous coronary intervention; IQR, interquartile range; NA, not available.

Table 3 Characteristics and outcomes of hospital discharges after coronary artery bypass graft among patients with and without COPD in Spain, from 2001 to 2011

	2001	2002	2003	2004	2005	2006	2007	2008	2009	2010	2011	P-value
No COPD
N	6,845	6,948	7,000	6,915	6,471	6,462	6,470	6,672	6,389	6,293	6,306	0.000
Incidence	34.5	34.61	34.15	33.1	30.37	29.75	29.29	29.72	28.04	27.32	27.08
Age, mean (SD)	65.68 (9.42)	65.78 (9.32)	66.01 (9.32)	66.44 (9.41)	66.79 (9.26)	67.22 (9.49)	66.96 (9.65)	67.07 (9.62)	67.19 (9.72)	67.32 (9.9)	67.68 (9.7)	0.000
Male, n (%)	5,259 (76.83)	5,325 (76.64)	5,306 (75.8)	5,239 (75.76)	4,880 (75.41)	4,976 (77)	4,959 (76.65)	5,102 (76.47)	4,930 (77.16)	4,779 (75.94)	4,905 (77.78)	0.052
CCI 0,a n (%)	3,949 (57.69)	3,848 (55.38)	3,612 (51.6)	3,504 (50.67)	3,080 (47.6)	2,929 (45.33)	3,002 (46.4)	2,963 (44.41)	2,716 (42.51)	2,727 (43.33)	2,713 (43.02)	0.000
CCI 1–2,a n (%)	2,800 (40.91)	2,964 (42.66)	3,226 (46.09)	3,248 (46.97)	3,193 (49.34)	3,322 (51.41)	3,279 (50.68)	3,460 (51.86)	3,423 (53.58)	3,293 (52.33)	3,370 (53.44)
CCI ≥3,a n (%)	96 (1.4)	136 (1.96)	162 (2.31)	163 (2.36)	198 (3.06)	211 (3.27)	189 (2.92)	249 (3.73)	250 (3.91)	273 (4.34)	223 (3.54)
LOS, median (IQR)	17 (16)	17 (16)	16 (16)	15 (14)	16 (16)	16 (14)	16 (15)	15 (14)	15 (13)	15 (12)	14 (14)	0.000
IHM, n (%)	606 (8.85)	581 (8.36)	520 (7.43)	496 (7.17)	478 (7.39)	465 (7.2)	452 (6.99)	472 (7.07)	383 (5.99)	395 (6.28)	373 (5.92)	0.000
COPD
N	538	607	683	669	658	595	658	631	632	576	601	0.000
Incidence	2.69	3	3.32	3.18	3.06	2.72	2.96	2.8	2.77	2.5	2.58
Age, mean (SD)	66.82 (8.34)	67.44 (8.59)	68.17 (8.38)	68.55 (8.08)	68.83 (8.5)	68.7 (8.31)	68.65 (8.21)	68.78 (8.54)	68.7 (8.49)	69.14 (8.56)	69.3 (8.45)	0.000
vMale, n (%)	507 (94.24)	564 (92.92)	640 (93.7)	626 (93.57)	610 (92.71)	555 (93.28)	618 (93.92)	590 (93.5)	583 (92.25)	536 (93.06)	551 (91.68)	0.864
CCI 0,a n (%)	296 (55.02)	300 (49.42)	302 (44.22)	298 (44.54)	279 (42.4)	241 (40.5)	281 (42.71)	230 (36.45)	217 (34.34)	211 (36.63)	211 (35.11)	0.000
CCI 1–2,a n (%)	227 (42.19)	289 (47.61)	356 (52.12)	339 (50.67)	354 (53.8)	334 (56.13)	346 (52.58)	380 (60.22)	385 (60.92)	331 (57.47)	344 (57.24)
CCI ≥3,a n (%)	15 (2.79)	18 (2.97)	25 (3.66)	32 (4.78)	25 (3.8)	20 (3.36)	31 (4.71)	21 (3.33)	30 (4.75)	34 (5.9)	46 (7.65)
LOS, median (IQR)	18 (19)	18 (18)	19 (18)	17 (18)	18 (18)	19 (18)	17 (17)	18 (16)	16 (16)	16 (15)	16 (16)	0.001
IHM, n (%)	57 (10.59)	51 (8.4)	64 (9.37)	45 (6.73)	48 (7.29)	49 (8.24)	54 (8.21)	53 (8.4)	38 (6.01)	36 (6.25)	36 (5.99)	0.056

Notes:

a CCI (Charlson comorbidity index): Comorbidities included in the CCI, except COPD and AMI. Incidence per 100,000. Incidence was calculated using the Spanish National Statistics Institute census projections, adjusted by sex and age.²¹

Abbreviations: AMI, acute myocardial infarction; n, number of procedures; IHM, in-hospital mortality; LOS, length of stay; SD, standard deviation; IQR, interquartile range.

Población residente por fecha, sexo y edad. [Population estimates by date, sex, and age]2015MadridInstituto Nacional de Estadística Available from: http://www.ine.es/jaxiT3/Tabla.htm?t=9663Accessed October 12, 2015 Spanish

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