COPD, 00:1–8, 2015 ISSN: 1541-2555 print / 1541-2563 online Copyright © Informa Healthcare USA, Inc. DOI: 10.3109/15412555.2014.995293
ORIGINAL RESEARCH
Relationship between Troponin Elevation, Cardiovascular History and Adverse Events in Patients with acute exacerbation of COPD
COPD Downloaded from informahealthcare.com by University of Connecticut on 04/12/15 For personal use only.
Gianluca Campo,1,2 Rita Pavasini,1 Michele Malagù,1 Silvia Punzetti,1 Nicola Napoli,3 Franco Guerzoni,3 Alberto Papi,4 Claudio Ceconi,1,2 and Marco Contoli3 1
Cardiovascular Institute, Azienda OspedalieroUniversitaria S.Anna, Cona (FE), Italy
2
Laboratorio per le Tecnologie delle Terapie Avanzate (LTTA) Center, Ferrara, Italy
3
Programmazione e controllo di gestione, Statistica Sanitaria, Azienda Ospedaliero-Universitaria S.Anna, Ferrara, Italy
4
Research Centre on Asthma and COPD, Section of Internal and Cardio-Respiratory Medicine, University of Ferrara, Cona, Italy
ABSTRACT Evidence suggests that troponin (Tn) elevation during acute exacerbation of chronic obstructive pulmonary disease (AECOPD) may predict an increase in mortality risk. We performed an observational study of 935 patients admitted to hospital for AECOPD from January 2010 to December 2012. Principal clinical and laboratory data were recorded, especially ischemic heart disease (IHD) history, Tn T values and cardiovascular drug prescription. The occurrence of all-cause death, cardiac death (CD), nonfatal myocardial infarction (MI), heart failure and cerebrovascular accident (CVA) was assessed on December 2013. Overall, 694 patients respected inclusion and exclusion criteria. We identified 210 (30%) patients without Tn elevation (negative Tn T group) and 484 (70%) patients with Tn elevation (positive Tn T group). With the exception of CVA, all adverse events were significantly higher in positive Tn T group as compared to negative Tn T group. At multivariable analysis, positive Tn T failed to predict all-cause death. Contrarily, positive Tn T emerged as independent predictors of CD (HR 1.61, 95%CI 1.2–2.2, p = 0.04), nonfatal MI (HR 3.12, 95%CI 1.4–8.1, p = 0.03) and composite endpoint including CD and nonfatal MI (HR 1.73, 95%CI 1.2–2.7, p = 0.03). Of note, positive Tn T stratified prognosis in patients without IHD history, but not in those with IHD history. In conclusion, after hospital admission for AECOPD, we observed a significant increase in the risk of cardiac adverse events in patients with Tn T elevation, especially in those without IHD history.
Introduction
Keywords: Acute exacerbation, chronic obstructive pulmonary disease, myocardial infarction, cardiac death, troponin Correspondence to: Dr. Gianluca Campo, Cardiovascular Institute, Azienda Ospedaliera Universitaria S.Anna di Ferrara, Cona (FE) 44124, Italy, phone: 00390532237227, fax: 00390532241885, email: [email protected]
The natural history of chronic obstructive pulmonary disease (COPD) is punctuated by recurrent episodes of exacerbation (1). Ischemic heart disease (IHD) is frequently associated with COPD, and the risk of cardiac adverse events appears to be particularly high after acute exacerbation of COPD (AECOPD) (1–4). Several authors investigated the prognostic role of the most common marker of cardiac injury, the cardiac troponin (Tn), in patients with AECOPD, showing a significant association between Tn elevation and all-cause mortality (5–11). Nevertheless, the relationship between Tn elevation during AECOPD, cardiac adverse events, IHD history and cardiovascular therapy (e.g. antiplatelet agents) remains unclear. The aim of this analysis is to describe the long-term occurrence of cardiac adverse events in patients admitted to hospital for AECOPD and their relationship with IHD history, troponin elevation and cardiovascular treatment. 1
2
Campo et al.
COPD Downloaded from informahealthcare.com by University of Connecticut on 04/12/15 For personal use only.
Materials and Methods Study population According to similar studies (8,12), inclusion criteria were: admission to our University Hospital (from January 2010 to December 2012) with a primary diagnosis of AECOPD and prior diagnosis of COPD confirmed by spirometry. Exclusion criteria were: previous diagnosis of sarcoidosis, interstitial lung disease, asthma, bronchiectasis or neuromuscular disease, community-acquired pneumonia, pulmonary embolism, recent myocardial infarction (MI) and/or percutaneous coronary intervention and/or surgical coronary revascularization and/or heart failure (
ORIGINAL RESEARCH
Relationship between Troponin Elevation, Cardiovascular History and Adverse Events in Patients with acute exacerbation of COPD
COPD Downloaded from informahealthcare.com by University of Connecticut on 04/12/15 For personal use only.
Gianluca Campo,1,2 Rita Pavasini,1 Michele Malagù,1 Silvia Punzetti,1 Nicola Napoli,3 Franco Guerzoni,3 Alberto Papi,4 Claudio Ceconi,1,2 and Marco Contoli3 1
Cardiovascular Institute, Azienda OspedalieroUniversitaria S.Anna, Cona (FE), Italy
2
Laboratorio per le Tecnologie delle Terapie Avanzate (LTTA) Center, Ferrara, Italy
3
Programmazione e controllo di gestione, Statistica Sanitaria, Azienda Ospedaliero-Universitaria S.Anna, Ferrara, Italy
4
Research Centre on Asthma and COPD, Section of Internal and Cardio-Respiratory Medicine, University of Ferrara, Cona, Italy
ABSTRACT Evidence suggests that troponin (Tn) elevation during acute exacerbation of chronic obstructive pulmonary disease (AECOPD) may predict an increase in mortality risk. We performed an observational study of 935 patients admitted to hospital for AECOPD from January 2010 to December 2012. Principal clinical and laboratory data were recorded, especially ischemic heart disease (IHD) history, Tn T values and cardiovascular drug prescription. The occurrence of all-cause death, cardiac death (CD), nonfatal myocardial infarction (MI), heart failure and cerebrovascular accident (CVA) was assessed on December 2013. Overall, 694 patients respected inclusion and exclusion criteria. We identified 210 (30%) patients without Tn elevation (negative Tn T group) and 484 (70%) patients with Tn elevation (positive Tn T group). With the exception of CVA, all adverse events were significantly higher in positive Tn T group as compared to negative Tn T group. At multivariable analysis, positive Tn T failed to predict all-cause death. Contrarily, positive Tn T emerged as independent predictors of CD (HR 1.61, 95%CI 1.2–2.2, p = 0.04), nonfatal MI (HR 3.12, 95%CI 1.4–8.1, p = 0.03) and composite endpoint including CD and nonfatal MI (HR 1.73, 95%CI 1.2–2.7, p = 0.03). Of note, positive Tn T stratified prognosis in patients without IHD history, but not in those with IHD history. In conclusion, after hospital admission for AECOPD, we observed a significant increase in the risk of cardiac adverse events in patients with Tn T elevation, especially in those without IHD history.
Introduction
Keywords: Acute exacerbation, chronic obstructive pulmonary disease, myocardial infarction, cardiac death, troponin Correspondence to: Dr. Gianluca Campo, Cardiovascular Institute, Azienda Ospedaliera Universitaria S.Anna di Ferrara, Cona (FE) 44124, Italy, phone: 00390532237227, fax: 00390532241885, email: [email protected]
The natural history of chronic obstructive pulmonary disease (COPD) is punctuated by recurrent episodes of exacerbation (1). Ischemic heart disease (IHD) is frequently associated with COPD, and the risk of cardiac adverse events appears to be particularly high after acute exacerbation of COPD (AECOPD) (1–4). Several authors investigated the prognostic role of the most common marker of cardiac injury, the cardiac troponin (Tn), in patients with AECOPD, showing a significant association between Tn elevation and all-cause mortality (5–11). Nevertheless, the relationship between Tn elevation during AECOPD, cardiac adverse events, IHD history and cardiovascular therapy (e.g. antiplatelet agents) remains unclear. The aim of this analysis is to describe the long-term occurrence of cardiac adverse events in patients admitted to hospital for AECOPD and their relationship with IHD history, troponin elevation and cardiovascular treatment. 1
2
Campo et al.
COPD Downloaded from informahealthcare.com by University of Connecticut on 04/12/15 For personal use only.
Materials and Methods Study population According to similar studies (8,12), inclusion criteria were: admission to our University Hospital (from January 2010 to December 2012) with a primary diagnosis of AECOPD and prior diagnosis of COPD confirmed by spirometry. Exclusion criteria were: previous diagnosis of sarcoidosis, interstitial lung disease, asthma, bronchiectasis or neuromuscular disease, community-acquired pneumonia, pulmonary embolism, recent myocardial infarction (MI) and/or percutaneous coronary intervention and/or surgical coronary revascularization and/or heart failure (
