Background
Methods
Data sources and search strategies
Inclusion criteria
Exclusion criteria
Definitions, outcomes and follow ups
Studies | Definitions |
---|---|
Almagro 2015 | COPD was defined as a post-bronchodilator forced expiratory volume in the 1st second (FEV1)/forced vital capacity (FVC) ratio < 0.70. |
Berger 2004 | COPD was defined by the requirement of chronic bronchodilator therapy or a forced expiratory volume in 1 s < 75% of the predicted value or a room air pO2 < 60 or a pCO2 > 50. |
Campo 2013 | A patient was considered to have COPD combining different sources of data: i) documented history of hospital admission for COPD; ii) treatment with pharmacologic therapies specific for COPD (e.g., inhaled steroids, inhaled anticholinergics, inhaled β-agonists or theophylline). |
Enriquez 2011 | COPD was defined as a history or presence of physician-diagnosed COPD. Additionally, the patients were required to be on chronic pharmacologic therapy and/or have an FEV1 < 75% of predicted value. |
Jatene 2016 | The presence of COPD was determined clinically by local investigators, based on history, clinical presentation, previous examinations, and medications, recorded as COPD in the case report form at enrollment. |
Konecny 2010 | Very severe COPD was defined as an FEV 1 /FVC ratio ≤ 70% and an FEV 1 ≤ 30% predicted, severe COPD as an FEV 1/FVC ratio ≤ 70% and an FEV 1 between 30% and 50% predicted, and mild-to-moderate COPD as an FEV 1/FVC ratio ≤ 70 and an FEV 1 > 50% predicted. |
Nishiyama 2009 | A patient was considered to have COPD if it was listed as a comorbid condition in our database and its diagnosis was confirmed by a simple test called spirometry. Such a diagnosis should be considered in any patient who has symptoms of cough, sputum production, or dyspnea (difficult or labored breathing), and/or a history of exposure to risk factors for the disease. In cases where spirometry is unavailable, the diagnosis of COPD should be made using all available tools. Clinical symptoms and signs such as abnormal shortness of breath and increased forced expiratory time can be used to arrive at the diagnosis. |
Selvaraj 2005 | The diagnosis of COPD was based on the clinical history or obtained from chart review and recorded as a co-morbidity in the database. |
Sung 2013 | COPD was defined according to one of the following criteria: (1) Information on COPD status was obtained by reviewing chart record of the need for pharmacologic therapy using bronchodilator agent; (2) Past history of a 1-s forced expiratory volume < 70% of the predicted value (by pulmonary function test); (3) Physical examination (by auscultation) showed expiratory wheezing and further confirmed by blood gas and chest radiograph (i.e., emphysematous change); or (4) Current use of bronchodilators prior to acute myocardial infarction. |
Zhang 2012 | A diagnosis of COPD should be considered in any patient who has symptoms of cough, sputum production, or dyspnea, and/or a history of exposure to risk factors for the disease. The diagnosis is confirmed by spirometry. The presence of a postbronchodilator FEV1 < 80% of the predicted value in combination with an FEV1/FVC < 70% confirms the presence of airflow limitation that is not fully reversible. Where spirometry is unavailable, the diagnosis of COPD should be made using all available tools. |
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In-hospital follow up
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A longer follow up period greater than one year.
Outcomes | Definitions |
---|---|
Major adverse cardiac events (MACEs) | Defined as a combination of several outcomes including death, MI and revascularization |
Death | Defined as all-cause mortality, that is, mortality due to any medical reason including cardiac and non-cardiac |
Myocardial infarction (MI) | Defined as re-infarction that occurred post percutaneous coronary intervention based on two or more of the following: 1. Typical chest pain, 2. ECG showing ST-T or Q wave changes, 3. Increase in serum enzyme (creatinine kinase, lactate dehydrogenase or troponin), 4. New wall motion abnormalities on ultrasound |
Coronary revascularization (CR) | Defined as repeated revascularization in the coronary arteries resulting in re-stenosis |
In-hospital follow-up | Defined as the follow-up period during their hospital stay (≤ 1 month) |
Long-term follow-up | Defined as the follow-up period of one or more years |
Studies | Outcomes | Follow up period |
---|---|---|
Almagro 2015 [8] | Death | 3 years |
Berger 2004 [9] | MACEs, MI | In-hospital |
Campo 2013 [10] | Death, MI, CR | In-hospital and 3 years |
Enriquez 2011 [3] | Death, MI, MACEs, CR | In-hospital and 1 year |
Jatene 2016 [11] | Death, MACEs, MI, CR | 2 years |
Konecny 2010 [12] | Death, MI | 10 years |
Nishiyama 2009 [13] | Death, MACEs, MI | In-hospital, 1–4 years |
Selvaraj 2005 [14] | Death, MI | In-hospital |
Sung 2013 [4] | MACEs | 1 year |
Zhang 2012 [15] | Death, MI, MACEs, CR | In-hospital |
Data extraction and review
Studies | Stars allocated following NOS assessment | No of stars (n) |
---|---|---|
Almagro 2015 | ******* | 7 |
Berger 2004 | ****** | 6 |
Campo 2013 | ******** | 8 |
Enriquez 2011 | ******* | 7 |
Konecny 2010 | ******** | 8 |
Nishiyama 2009 | ******* | 7 |
Selvaraj 2005 | ****** | 6 |
Sung 2013 | ****** | 6 |
Zhang 2012 | ****** | 6 |
Statistical analysis
Results
Flow of study selection
General features of the studies which were included
Studies | Patients enrollment period | Types of study | No of patients with COPD (n) | No of patients without COPD (n) | Total no of patients (n) |
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Almagro 2015 | 2011 | Observational | 33 | 100 | 133 |
Berger 2004 | 1998–1999 | Observational | 183 | 4101 | 4284 |
Campo 2013 | 2003–2009 | Observational | 2032 | 9086 | 11,118 |
Enriquez 2011 | 1997–2006 | Observational | 860 | 10,048 | 10,908 |
Jatene 2016 | - | RCT | 283 | 4322 | 4605 |
Konecny 2010 | 2005–2008 | Observational | 2001 | 12,345 | 14,346 |
Nishiyama 2009 | 2000–2002 | Observational | 240 | 9632 | 9872 |
Selvaraj 2005 | 1997–2003 | Observational | 1117 | 9877 | 10,994 |
Sung 2013 | 2002–2011 | Observational | 124 | 1430 | 1554 |
Zhang 2012 | 2006–2011 | Observational | 645 | 4510 | 5155 |
Total (n) | 7518 | 65,451 | 72,969 |
Baseline features of the studies which were included
Studies | Age (yrs) | Males (%) | Ht (%) | Ds (%) | Cs (%) | DM (%) |
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+/−
|
+/−
|
+/−
|
+/−
|
+/−
|
+/−
| |
Almagro 2015 | 67.5/61.6 | 84.8/76.0 | 69.7/69.0 | 66.7/62.0 | 18.2/17.0 | 36.4/27.0 |
Berger 2004 | 66.1/63.3 | 56.0/69.0 | 71.0/70.0 | − | 30.0/22.0 | 30.0/27.0 |
Campo 2013 | 70.0/65.0 | 66.0/74.0 | 70.0/61.0 | 46.8/48.3 | 24.0/27.0 | 21.8/20.9 |
Enriquez 2011 | 66.8/63.2 | 57.0/66.1 | 78.1/69.7 | 67.0/70.0 | 30.9/24.4 | 36.9/30.2 |
Jatene 2016 | 67.8/63.0 | 75.6/76.7 | 74.6/63.6 | 67.8/63.0 | 42.4/33.8 | 24.4/16.8 |
Konecny 2010 | 69.9/66.0 | 72.0/70.0 | 74.0/70.0 | 73.0/76.0 | 30.0/17.0 | 26.0/24.0 |
Nishiyama 2009 | − | 82.5/70.4 | 62.5/69.2 | − | 43.8/35.7 | 31.7/39.0 |
Selvaraj 2005 | 67.6/64.1 | 62.0/71.1 | 75.1/71.6 | 17.2/20.1 | 27.0/18.0 | 37.2/30.5 |
Sung 2013 | 68.5/60.9 | 85.5/81.2 | 54.8/55.6 | 39.5/42.3 | 37.1/34.5 | 32.3/36.2 |
Zhang 2012 | 68.4/64.7 | 73.0/71.0 | 75.0/71.0 | 65.0/63.0 | 38.0/29.0 | 25.0/22.0 |
MACEs following PCI in patients with COPD versus patients without COPD
Mortality following PCI in COPD versus non-COPD
Other outcomes following PCI in patients with versus without COPD
Analysis including patients with COPD which was confirmed by a spirometry test
Outcomes analyzed | No of studies included | OR with 95% CI |
P value | I2 (%) |
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In-hospital follow up | ||||
MACEs | 4 | 1.40 [1.19–1.65] | 0.0001 | 0 |
MACEs | 3 | 1.21 [0.92–1.59] | 0.17 | 0 |
Death | 4 | 2.25 [1.78–2.85] | 0.00001 | 0 |
MI | 4 | 1.06 [0.82–1.36] | 0.67 | 0 |
CR | 2 | 1.32 [0.95–1.81] | 0.09 | 13 |
Above 1 year follow up | ||||
MACEs | 3 | 1.58 [1.38–1.81] | 0.00001 | 29 |
MACEs | 2 | 1.90 [1.46–2.48] | 0.00001 | 0 |
Death | 6 | 2.22 [1.33–3.71] | 0.002 | 97 |
MI | 2 | 1.37 [0.92–2.04] | 0.12 | 19 |
CR | 2 | 1.15 [0.90–1.46] | 0.26 | 0 |
Discussion
Novelty
Limitations
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Even though a large number of patients was used, this number might still be small compared to other studies outside this scope.
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Most of the studies which were included were observational studies with heterogeneous data. Therefore, the subgroup analyzing long-term mortality involved a very high level of heterogeneity.
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In addition, different studies had different follow-up periods further contributing to this high level of heterogeneity when analyzing long-term mortality.
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When other clinical outcomes (MI and CR) were analyzed, in some cases, the number of patients were adjusted to avoid the influence of studies with larger number of patients. This might also have affect the results for other clinical outcomes.
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Important endpoints were not reported in all the studies. A few studies reported MACEs while others reported mortality. Therefore, only a few studies were available for comparison during the subgroup analysis.