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Предикторы повторной реваскуляризации миокарда в отдаленном периоде после чрескожных коронарных вмешательств у больных с сочетанием ишемической болезни сердца и хронической обструктивной болезни легких
Предикторы повторной реваскуляризации миокарда в отдаленном периоде после чрескожных коронарных вмешательств у больных с сочетанием ишемической болезни сердца и хронической обструктивной болезни легких
Зафираки В.К., Скалецкий К.В., Космачева Е.Д. Предикторы повторной реваскуляризации миокарда в отдаленном периоде после чрескожных коронарных вмешательств у больных с сочетанием ишемической болезни сердца и хронической обструктивной болезни легких. CardioСоматика. 2019; 10 (4): 6–11. DOI: 10.26442/22217185.2019.4.190664
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Аннотация
Цель. Оценить влияние сопутствующей хронической обструктивной болезни легких (ХОБЛ) на частоту повторной реваскуляризации миокарда (РМ) у больных с ишемической болезнью сердца (ИБС) после выполнения чрескожных коронарных вмешательств (ЧКВ), а также установить независимые предикторы повторной РМ у этих больных.
Материалы и методы. В проспективное когортное исследование включены 646 больных с ИБС, из них у 254 имелась сопутствующая ХОБЛ. Всем больным выполняли ЧКВ (46,9% вмешательств в группе ХОБЛ и 44,9% в контрольной группе были выполнены в связи с острым коронарным синдромом, остальные ЧКВ – плановые). В ходе наблюдения длительностью до 36 мес регистрировали частоту повторной РМ и время до ее выполнения. Предикторы повторной РМ были идентифицированы с помощью регрессии Кокса.
Результаты. Сопутствующая ХОБЛ увеличивает риск повторной РМ в 1,46 раза (95% доверительный интервал – ДИ 1,03–2,06), повторного ЧКВ – в 1,62 раза (95% ДИ 1,03–2,32) и сопровождается более ранним наступлением необходимости в выполнении РМ. Независимыми предикторами повторной РМ в регрессионной модели Кокса являются: скорость клубочковой фильтрации (p=0,001), лодыжечно-плечевой индекс (p=0,004), частые обострения ХОБЛ (p=0,028), количество стенозов в основных ветвях коронарных артерий (p=0,039), концентрация С-реактивного белка в крови (p=0,066).
Заключение. ХОБЛ является значимым фактором риска повторной РМ после выполнения ЧКВ при острых и хронических формах ИБС и приводит к более раннему его выполнению. Наиболее высокий риск повторной РМ отмечается у больных ХОБЛ с частыми обострениями.
Ключевые слова: ишемическая болезнь сердца, повторная реваскуляризация миокарда, хроническая обструктивная болезнь легких, предикторы.
Materials and methods. A prospective cohort study included 646 patients with CAD, of which 254 had concominant COPD. All patients underwent PCI (46.9% for acute coronary syndrome in the main group and 44.9% in the control group. Remaining interventions were elective). The frequency of repeat myocardial revascularization and the time till re-intervention was registered during the follow-up period up to 36 months.
Results. COPD increases risk of repeat myocardial revascularization (hazard ratio – HR 1.46; 95% confidence interval – CI 1.03–2.06), repeat PCI (HR 1.62; 95% CI 1.03–2.32) and is accompanied by an earlier onset of re-intervention. An independent predictors of repeat myocardial revascularization in the Cox regression model are: glomerular filtration rate (p=0.001), ankle-brachial index (p=0.004), frequent exacerbations of COPD (p=0.028), total number of coronary artery stenosis (p=0.039) and blood concentration of C-reactive protein (p=0.066).
Conclusions. COPD is a significant risk factor of re-intervention after PCI in patients with acute and chronic forms of CAD and leads to its earlier performing. The patients with frequent COPD exacerbations have the highest risk of repeat myocardial revascularization during follow-up.
Key words: coronary artery disease, repeated myocardial revascularization, chronic obstructive pulmonary disease, predictors.
Материалы и методы. В проспективное когортное исследование включены 646 больных с ИБС, из них у 254 имелась сопутствующая ХОБЛ. Всем больным выполняли ЧКВ (46,9% вмешательств в группе ХОБЛ и 44,9% в контрольной группе были выполнены в связи с острым коронарным синдромом, остальные ЧКВ – плановые). В ходе наблюдения длительностью до 36 мес регистрировали частоту повторной РМ и время до ее выполнения. Предикторы повторной РМ были идентифицированы с помощью регрессии Кокса.
Результаты. Сопутствующая ХОБЛ увеличивает риск повторной РМ в 1,46 раза (95% доверительный интервал – ДИ 1,03–2,06), повторного ЧКВ – в 1,62 раза (95% ДИ 1,03–2,32) и сопровождается более ранним наступлением необходимости в выполнении РМ. Независимыми предикторами повторной РМ в регрессионной модели Кокса являются: скорость клубочковой фильтрации (p=0,001), лодыжечно-плечевой индекс (p=0,004), частые обострения ХОБЛ (p=0,028), количество стенозов в основных ветвях коронарных артерий (p=0,039), концентрация С-реактивного белка в крови (p=0,066).
Заключение. ХОБЛ является значимым фактором риска повторной РМ после выполнения ЧКВ при острых и хронических формах ИБС и приводит к более раннему его выполнению. Наиболее высокий риск повторной РМ отмечается у больных ХОБЛ с частыми обострениями.
Ключевые слова: ишемическая болезнь сердца, повторная реваскуляризация миокарда, хроническая обструктивная болезнь легких, предикторы.
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Materials and methods. A prospective cohort study included 646 patients with CAD, of which 254 had concominant COPD. All patients underwent PCI (46.9% for acute coronary syndrome in the main group and 44.9% in the control group. Remaining interventions were elective). The frequency of repeat myocardial revascularization and the time till re-intervention was registered during the follow-up period up to 36 months.
Results. COPD increases risk of repeat myocardial revascularization (hazard ratio – HR 1.46; 95% confidence interval – CI 1.03–2.06), repeat PCI (HR 1.62; 95% CI 1.03–2.32) and is accompanied by an earlier onset of re-intervention. An independent predictors of repeat myocardial revascularization in the Cox regression model are: glomerular filtration rate (p=0.001), ankle-brachial index (p=0.004), frequent exacerbations of COPD (p=0.028), total number of coronary artery stenosis (p=0.039) and blood concentration of C-reactive protein (p=0.066).
Conclusions. COPD is a significant risk factor of re-intervention after PCI in patients with acute and chronic forms of CAD and leads to its earlier performing. The patients with frequent COPD exacerbations have the highest risk of repeat myocardial revascularization during follow-up.
Key words: coronary artery disease, repeated myocardial revascularization, chronic obstructive pulmonary disease, predictors.
Полный текст
Список литературы
1. Naito R, Kasai T. Coronary artery disease in type 2 diabetes mellitus: recent treatment strategies and future perspectives. World J Cardiol 2015; 7 (3): 119–24. DOI: 10.4330/wjc.v7.i3.119
2. Chen YY, Wang JF, Zhang YJ et al. Optimal strategy of coronary revascularization in chronic kidney disease patients: a meta-analysis. Eur J Int Med 2013; 24 (4): 354–61. DOI: 10.1016/j.ejim.2013.03.010
3. Șerban RC, Hadadi L, Șuș I et al. Impact of chronic obstructive pulmonary disease on in-hospital morbidity and mortality in patients with ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention. Int J Cardiol 2017; 243: 437–42. DOI:10.1016/j.ijcard.2017.05.044
4. Bundhun PK, Gupta C, Xu GM. Major adverse cardiac events and mortality in chronic obstructive pulmonary disease following percutaneous coronary intervention: a systematic review and meta-analysis. BMC Cardiovasc Disord 2017; 17 (1): 191. DOI: 10.1186/s12872-017-0622-2
5. Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2011. https://www.volgmed.ru/uploads/files/2013-3/17409-globalnaya_strategiya_diagnostiki_lecheniya_i_prof...
6. Lang RM, Badano LP, Mor-Avi V et al. Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2005. https://www.onlinejase.com/article/S0894-7317(14)00745-7/pdf
7. Mohr FW, Morice MC, Kappetein AP et al. Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial. Lancet 2013; 381: 629–38. DOI: 10.1016/S0140-6736(13)60141-5
8. King PT. Inflammation in chronic obstructive pulmonary disease and its role in cardiovascular disease and lung cancer. Clin Translat Med 2015; 4: 643–50. DOI: 10.1186/s40169-015-0068-z
9. Suissa S, Dell'Aniello S, Ernst P. Long-term natural history of chronic obstructive pulmonary disease: severe exacerbations and mortality. Thorax 2012; 67: 957–63. DOI: 10.1136/thoraxjnl-2011-201518
10. Campo G, Pavasini R, Malagù M et al. Chronic obstructive pulmonary disease and ischemic heart disease comorbidity: overview of mechanisms and clinical management. Cardiovasc Drugs Ther 2015; 29 (2): 147–57. DOI: 10.1007/s10557-014-6569-y
11. Roversi S, Roversi P, Spadafora G et al. Coronary artery disease concomitant with chronic obstructive pulmonary disease. Eur J Clin Invest 2014; 44 (1): 93–102. DOI: 10.1111/eci.12181
12. Enriquez JR, Parikh SV, Selzer F et al. Increased adverse events after percutaneous coronary intervention in patients with COPD: insights from the National Heart, Lung, and Blood Institute dynamic registry. Chest 2011; 140 (3): 604–10. DOI: 10.1378/chest.10-2644
13. Campo G, Guastaroba P, Marzocchi A et al. Impact of COPD on long-term outcome after ST-segment elevation myocardial infarction receiving primary percutaneous coronary intervention. Chest 2013; 144 (3): 750–7. DOI: 10.1378/chest.12-2313
14. Lin WC, Chen CW, Lu CL et al. The association between recent hospitalized COPD exacerbations and adverse outcomes after percutaneous coronary intervention: a nationwide cohort study. Int J Chron Obstruct Pulmon Dis 2019; 14: 169–79. DOI: 10.2147/COPD.S187345
15. Dubé BP, Vermeulen F, Laveneziana P. Exertional Dyspnoea in Chronic Respiratory Diseases: From Physiology to Clinical Application. Arch Broncopneumol 2017; 53 (2): 62–70. DOI: 10.1016/j.arbres.2016.09.005
2. Chen YY, Wang JF, Zhang YJ et al. Optimal strategy of coronary revascularization in chronic kidney disease patients: a meta-analysis. Eur J Int Med 2013; 24 (4): 354–61. DOI: 10.1016/j.ejim.2013.03.010
3. Șerban RC, Hadadi L, Șuș I et al. Impact of chronic obstructive pulmonary disease on in-hospital morbidity and mortality in patients with ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention. Int J Cardiol 2017; 243: 437–42. DOI:10.1016/j.ijcard.2017.05.044
4. Bundhun PK, Gupta C, Xu GM. Major adverse cardiac events and mortality in chronic obstructive pulmonary disease following percutaneous coronary intervention: a systematic review and meta-analysis. BMC Cardiovasc Disord 2017; 17 (1): 191. DOI: 10.1186/s12872-017-0622-2
5. Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2011. https://www.volgmed.ru/uploads/files/2013-3/17409-globalnaya_strategiya_diagnostiki_lecheniya_i_prof...
6. Lang RM, Badano LP, Mor-Avi V et al. Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2005. https://www.onlinejase.com/article/S0894-7317(14)00745-7/pdf
7. Mohr FW, Morice MC, Kappetein AP et al. Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial. Lancet 2013; 381: 629–38. DOI: 10.1016/S0140-6736(13)60141-5
8. King PT. Inflammation in chronic obstructive pulmonary disease and its role in cardiovascular disease and lung cancer. Clin Translat Med 2015; 4: 643–50. DOI: 10.1186/s40169-015-0068-z
9. Suissa S, Dell'Aniello S, Ernst P. Long-term natural history of chronic obstructive pulmonary disease: severe exacerbations and mortality. Thorax 2012; 67: 957–63. DOI: 10.1136/thoraxjnl-2011-201518
10. Campo G, Pavasini R, Malagù M et al. Chronic obstructive pulmonary disease and ischemic heart disease comorbidity: overview of mechanisms and clinical management. Cardiovasc Drugs Ther 2015; 29 (2): 147–57. DOI: 10.1007/s10557-014-6569-y
11. Roversi S, Roversi P, Spadafora G et al. Coronary artery disease concomitant with chronic obstructive pulmonary disease. Eur J Clin Invest 2014; 44 (1): 93–102. DOI: 10.1111/eci.12181
12. Enriquez JR, Parikh SV, Selzer F et al. Increased adverse events after percutaneous coronary intervention in patients with COPD: insights from the National Heart, Lung, and Blood Institute dynamic registry. Chest 2011; 140 (3): 604–10. DOI: 10.1378/chest.10-2644
13. Campo G, Guastaroba P, Marzocchi A et al. Impact of COPD on long-term outcome after ST-segment elevation myocardial infarction receiving primary percutaneous coronary intervention. Chest 2013; 144 (3): 750–7. DOI: 10.1378/chest.12-2313
14. Lin WC, Chen CW, Lu CL et al. The association between recent hospitalized COPD exacerbations and adverse outcomes after percutaneous coronary intervention: a nationwide cohort study. Int J Chron Obstruct Pulmon Dis 2019; 14: 169–79. DOI: 10.2147/COPD.S187345
15. Dubé BP, Vermeulen F, Laveneziana P. Exertional Dyspnoea in Chronic Respiratory Diseases: From Physiology to Clinical Application. Arch Broncopneumol 2017; 53 (2): 62–70. DOI: 10.1016/j.arbres.2016.09.005
2. Chen YY, Wang JF, Zhang YJ et al. Optimal strategy of coronary revascularization in chronic kidney disease patients: a meta-analysis. Eur J Int Med 2013; 24 (4): 354–61. DOI: 10.1016/j.ejim.2013.03.010
3. Șerban RC, Hadadi L, Șuș I et al. Impact of chronic obstructive pulmonary disease on in-hospital morbidity and mortality in patients with ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention. Int J Cardiol 2017; 243: 437–42. DOI:10.1016/j.ijcard.2017.05.044
4. Bundhun PK, Gupta C, Xu GM. Major adverse cardiac events and mortality in chronic obstructive pulmonary disease following percutaneous coronary intervention: a systematic review and meta-analysis. BMC Cardiovasc Disord 2017; 17 (1): 191. DOI: 10.1186/s12872-017-0622-2
5. Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2011. https://www.volgmed.ru/uploads/files/2013-3/17409-globalnaya_strategiya_diagnostiki_lecheniya_i_prof...
6. Lang RM, Badano LP, Mor-Avi V et al. Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2005. https://www.onlinejase.com/article/S0894-7317(14)00745-7/pdf
7. Mohr FW, Morice MC, Kappetein AP et al. Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial. Lancet 2013; 381: 629–38. DOI: 10.1016/S0140-6736(13)60141-5
8. King PT. Inflammation in chronic obstructive pulmonary disease and its role in cardiovascular disease and lung cancer. Clin Translat Med 2015; 4: 643–50. DOI: 10.1186/s40169-015-0068-z
9. Suissa S, Dell'Aniello S, Ernst P. Long-term natural history of chronic obstructive pulmonary disease: severe exacerbations and mortality. Thorax 2012; 67: 957–63. DOI: 10.1136/thoraxjnl-2011-201518
10. Campo G, Pavasini R, Malagù M et al. Chronic obstructive pulmonary disease and ischemic heart disease comorbidity: overview of mechanisms and clinical management. Cardiovasc Drugs Ther 2015; 29 (2): 147–57. DOI: 10.1007/s10557-014-6569-y
11. Roversi S, Roversi P, Spadafora G et al. Coronary artery disease concomitant with chronic obstructive pulmonary disease. Eur J Clin Invest 2014; 44 (1): 93–102. DOI: 10.1111/eci.12181
12. Enriquez JR, Parikh SV, Selzer F et al. Increased adverse events after percutaneous coronary intervention in patients with COPD: insights from the National Heart, Lung, and Blood Institute dynamic registry. Chest 2011; 140 (3): 604–10. DOI: 10.1378/chest.10-2644
13. Campo G, Guastaroba P, Marzocchi A et al. Impact of COPD on long-term outcome after ST-segment elevation myocardial infarction receiving primary percutaneous coronary intervention. Chest 2013; 144 (3): 750–7. DOI: 10.1378/chest.12-2313
14. Lin WC, Chen CW, Lu CL et al. The association between recent hospitalized COPD exacerbations and adverse outcomes after percutaneous coronary intervention: a nationwide cohort study. Int J Chron Obstruct Pulmon Dis 2019; 14: 169–79. DOI: 10.2147/COPD.S187345
15. Dubé BP, Vermeulen F, Laveneziana P. Exertional Dyspnoea in Chronic Respiratory Diseases: From Physiology to Clinical Application. Arch Broncopneumol 2017; 53 (2): 62–70. DOI: 10.1016/j.arbres.2016.09.005
________________________________________________
2. Chen YY, Wang JF, Zhang YJ et al. Optimal strategy of coronary revascularization in chronic kidney disease patients: a meta-analysis. Eur J Int Med 2013; 24 (4): 354–61. DOI: 10.1016/j.ejim.2013.03.010
3. Șerban RC, Hadadi L, Șuș I et al. Impact of chronic obstructive pulmonary disease on in-hospital morbidity and mortality in patients with ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention. Int J Cardiol 2017; 243: 437–42. DOI:10.1016/j.ijcard.2017.05.044
4. Bundhun PK, Gupta C, Xu GM. Major adverse cardiac events and mortality in chronic obstructive pulmonary disease following percutaneous coronary intervention: a systematic review and meta-analysis. BMC Cardiovasc Disord 2017; 17 (1): 191. DOI: 10.1186/s12872-017-0622-2
5. Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2011. https://www.volgmed.ru/uploads/files/2013-3/17409-globalnaya_strategiya_diagnostiki_lecheniya_i_prof...
6. Lang RM, Badano LP, Mor-Avi V et al. Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2005. https://www.onlinejase.com/article/S0894-7317(14)00745-7/pdf
7. Mohr FW, Morice MC, Kappetein AP et al. Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial. Lancet 2013; 381: 629–38. DOI: 10.1016/S0140-6736(13)60141-5
8. King PT. Inflammation in chronic obstructive pulmonary disease and its role in cardiovascular disease and lung cancer. Clin Translat Med 2015; 4: 643–50. DOI: 10.1186/s40169-015-0068-z
9. Suissa S, Dell'Aniello S, Ernst P. Long-term natural history of chronic obstructive pulmonary disease: severe exacerbations and mortality. Thorax 2012; 67: 957–63. DOI: 10.1136/thoraxjnl-2011-201518
10. Campo G, Pavasini R, Malagù M et al. Chronic obstructive pulmonary disease and ischemic heart disease comorbidity: overview of mechanisms and clinical management. Cardiovasc Drugs Ther 2015; 29 (2): 147–57. DOI: 10.1007/s10557-014-6569-y
11. Roversi S, Roversi P, Spadafora G et al. Coronary artery disease concomitant with chronic obstructive pulmonary disease. Eur J Clin Invest 2014; 44 (1): 93–102. DOI: 10.1111/eci.12181
12. Enriquez JR, Parikh SV, Selzer F et al. Increased adverse events after percutaneous coronary intervention in patients with COPD: insights from the National Heart, Lung, and Blood Institute dynamic registry. Chest 2011; 140 (3): 604–10. DOI: 10.1378/chest.10-2644
13. Campo G, Guastaroba P, Marzocchi A et al. Impact of COPD on long-term outcome after ST-segment elevation myocardial infarction receiving primary percutaneous coronary intervention. Chest 2013; 144 (3): 750–7. DOI: 10.1378/chest.12-2313
14. Lin WC, Chen CW, Lu CL et al. The association between recent hospitalized COPD exacerbations and adverse outcomes after percutaneous coronary intervention: a nationwide cohort study. Int J Chron Obstruct Pulmon Dis 2019; 14: 169–79. DOI: 10.2147/COPD.S187345
15. Dubé BP, Vermeulen F, Laveneziana P. Exertional Dyspnoea in Chronic Respiratory Diseases: From Physiology to Clinical Application. Arch Broncopneumol 2017; 53 (2): 62–70. DOI: 10.1016/j.arbres.2016.09.005
Авторы
В.К. Зафираки*1, К.В. Скалецкий2, Е.Д. Космачева1,2
1 ФГБОУ ВО «Кубанский государственный медицинский университет» Минздрава России, Краснодар, Россия;
2 ГБУЗ «Научно-исследовательский институт – Краевая клиническая больница №1 им. проф. С.В. Очаповского» Минздрава Краснодарского края, Краснодар, Россия
*vzaphir@mail.ru
1 Kuban State Medical University, Krasnodar, Russia;
2 Scientific Research Institution – Ochapovsky Regional Clinical Hospital №1, Krasnodar, Russia
*vzaphir@mail.ru
1 ФГБОУ ВО «Кубанский государственный медицинский университет» Минздрава России, Краснодар, Россия;
2 ГБУЗ «Научно-исследовательский институт – Краевая клиническая больница №1 им. проф. С.В. Очаповского» Минздрава Краснодарского края, Краснодар, Россия
*vzaphir@mail.ru
________________________________________________
1 Kuban State Medical University, Krasnodar, Russia;
2 Scientific Research Institution – Ochapovsky Regional Clinical Hospital №1, Krasnodar, Russia
*vzaphir@mail.ru
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