Association of Chronic Obstructive Pulmonary Disease with Morbidity and Mortality in Patients with Peripheral Artery Disease: Insights from the EUCLID Trial

被引：7

作者：

Galani, Jemi ^{[1
]}

Mulder, Hillary ^{[2
]}

Rockhold, Frank W. ^{[2
]}

Weissler, E. Hope ^{[2
,3
]}

Baumgartner, Iris ^{[4
]}

Berger, Jeffrey S. ^{[5
,6
]}

Blomster, Juuso, I ^{[7
]}

Fowkes, F. Gerry R. ^{[8
]}

Hiatt, William R. ^{[9
,10
]}

Katona, Brian G. ^{[11
]}

Norgren, Lars ^{[12
]}

Mahaffey, Kenneth W. ^{[13
]}

Quint, Jennifer K. ^{[14
]}

Patel, Manesh R. ^{[1
,2
]}

Jones, W. Schuyler ^{[1
,2
]}

机构：

[1] Duke Univ, Dept Med, Med Ctr, Durham, NC 27710 USA

[2] Duke Univ, Sch Med, Duke Clin Res Inst, Durham, NC 27710 USA

[3] Duke Univ Hlth Syst, Dept Surg, Div Vasc Surg, Durham, NC USA

[4] Univ Bern, Swiss Cardiovasc Ctr, Dept Med, Bern, Switzerland

[5] NYU, Sch Med, Dept Med, New York, NY USA

[6] NYU, Sch Med, Dept Surg, New York, NY USA

[7] Univ Turku, Turku, Finland

[8] Univ Edinburgh, Usher Inst Populat Hlth Sci & Informat, Edinburgh, Midlothian, Scotland

[9] Univ Colorado, Div Cardiol, Sch Med, Aurora, CO USA

[10] CPC Clin Res, Aurora, CO USA

[11] AstraZeneca, Gaithersburg, MD USA

[12] Orebro Univ, Fac Med & Hlth, Orebro, Sweden

[13] Stanford Univ, Stanford Ctr Clin Res, Sch Med, Stanford, CA 94305 USA

[14] Imperial Coll London, Natl Heart & Lung Inst, Resp Epidemiol Occupat Med & Publ Hlth, London, England

来源：

INTERNATIONAL JOURNAL OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE | 2021年 / 16卷

关键词：

peripheral artery disease; chronic obstructive pulmonary disease; major adverse cardiovascular events; COPD; EXACERBATIONS; TICAGRELOR;

D O I：

10.2147/COPD.S292978

中图分类号：

R56 [呼吸系及胸部疾病];

学科分类号：

摘要：

Background: Patients with chronic obstructive pulmonary disease (COPD) are at increased risk of developing lower extremity peripheral artery disease (PAD) and suffering PAD-related morbidity and mortality. However, the effect and burden of COPD on patients with PAD is less well defined. This post hoc analysis from EUCLID aimed to analyze the risk of major adverse cardiovascular events (MACE) and major adverse limb events (MALE) in patients with PAD and concomitant COPD compared with those without COPD, and to describe the adverse events specific to patients with COPD. Methods: EUCLID randomized 13,885 patients with symptomatic PAD to monotherapy with either ticagrelor or clopidogrel for the prevention of MACE. In this analysis, MACE, MALE, mortality, and adverse events were compared between groups with and without COPD using unadjusted and adjusted Cox proportional hazards model. Results: Of the 13,883 patients with COPD status available at baseline, 11% (n=1538) had COPD. Patients with COPD had a higher risk of MACE (6.02 vs 4.29 events/100 patient-years; p<0.001) due to a significantly higher risk of myocardial infarction (MI) (3.55 vs 1.85 events/100 patient-years; p<0.001) when compared with patients without COPD. These risks persisted after adjustment (MACE: adjusted hazard ratio (aHR) 1.30, 95% confidence interval [CI] 1.11-1.52; p<0.001; MI: aHR 1.45, 95% CI 1.18-1.77; p<0.001). However, patients with COPD did not have an increased risk of MALE or major bleeding. Patients with COPD were more frequently hospitalized for dyspnea and pneumonia (2.66 vs 0.9 events/ 100 patient-years; aHR 2.77, 95% CI 2.12-3.63; p<0.001) and more frequently discontinued study drug prematurely (19.36 vs 12.54 events/100 patient-years; p<0.001; aHR 1.34, 95% CI 1.22-1.47; p<0.001). Conclusion: In patients with comorbid PAD and COPD, the risks of MACE, respiratory-related adverse events, and premature study drug discontinuation were higher when compared with patients without COPD.

引用

页码：841 / 851

页数：11

共 22 条

[1] Premature Ticagrelor Discontinuation in Secondary Prevention of Atherosclerotic CVD JACC Review Topic of the Week [J].