Work

ECG-based risk factors for adverse cardiopulmonary events and treatment outcomes in COPD

Year: 2024

Type: article

Abstract: Background COPD has high mortality, compounded by comorbid cardiovascular disease. We investigated two ECG markers, Cardiac Infarction Injury Score (CIIS) and P pulmonale, as prognostic tools for adverse cardiopulmonary events in COPD. Methods This was apost hocanalysis of the IMPACT trial. Outcomes included odds (odds ratio, 95% confidence intervals) of adverse cardiopulmonary events stratified by CIIS threshold (<20versus≥20) and P pulmonale (baseline). Events included all-cause death, hospitalisation or death, cardiovascular adverse event of special interest, severe COPD exacerbations, and moderate/severe COPD exacerbations. We also assessed the effects of fluticasone furoate/umeclidinium/vilanterolversusfluticasone furoate/vilanterol or umeclidinium/vilanterol based on CIIS and P pulmonale. Results We included 9448 patients. Patients with CIIS ≥20 (versusCIIS <20) had greater odds of all-cause death (OR 1.73, 95% CI 1.27–2.37, p<0.001), hospitalisation or death (OR 1.33, 95% CI 1.17–1.50, p<0.001), cardiovascular adverse event of special interest (OR 1.27, 95% CI 1.08–1.48, p<0.005), severe COPD exacerbations (OR 1.41, 95% CI 1.21–1.64, p<0.001) and moderate/severe COPD exacerbations (OR 1.25, 95% CI 1.13–1.40, p<0.001). Patients with P pulmonale (versuswithout) had greater odds of all-cause death (OR 2.25, 95% CI 1.54–3.29, p<0.001), hospitalisation or death (OR 1.51, 95% CI 1.28–1.79, p<0.001), severe COPD exacerbations (OR 2.00, 95% CI 1.65–2.41, p<0.001) and moderate/severe COPD exacerbations (OR 1.25, 95% CI 1.08–1.46, p<0.001). A combined model demonstrated that patients with CIIS ≥20 and P pulmonale had increased risk of all-cause death (OR 3.38, 95% CI 1.23–9.30, p=0.019), hospitalisation or death (OR 1.61, 95% CI 1.14–2.22, p=0.004) and rate of severe COPD exacerbations (OR 1.89, 95% CI 1.22–2.91, p=0.004) and moderate/severe COPD exacerbations (OR 1.25, 95% CI 1.00–1.56, p=0.046). The risk of all-cause death and cardiovascular adverse events of special interest was reduced with fluticasone furoate/umeclidinium/vilanterolversusumeclidinium/vilanterol in patients with CIIS ≥20, but not CIIS <20. Conclusions These findings suggest the potential clinical relevance of CIIS and P pulmonale as risk indicators for adverse cardiopulmonary events in COPD.

Source: European Respiratory Journal

DOI: 10.1183/13993003.00171-2024