O7.2.5 Coronary revascularisation procedures

Patients with COPD are at increased risk of death and complications following cardiac surgery [evidence level III-2]. A study identified 1169 patients undergoing coronary artery bypass grafts and / or valve replacement at one US centre who had preoperative lung function tests (Adabag 2010). Operative mortality was 2% in those with no or mild airflow limitation, compared to 6.7% among those with moderate or severe airflow limitation (FEV1/FVC < 70% and FEV1 < 80% predicted). Postoperative mortality was 3.2 (95%CI 1.6-6.2) fold higher among those with moderate or severe airflow limitation and 4.9 (2.3-10.8) fold higher among those with diffusing capacity 48 hours and stayed longer in intensive care and hospital than those with normal lung function.

COPD and COPD severity as defined by spirometry were also associated with increased mortality (OR 1.79, CI 1.63 to 1.96), cardiac mortality (OR 1.57, CI 1.35 to 1.81) and post-discharge MI (OR 1.3, CI 1.14 to 1.47) after percutaneous coronary intervention in multivariate analysis, despite equivalent procedural success and complication rates (Konecny 2010) [evidence level III- 2]. In this study, data prospectively collected for 14,346 patients (2001 COPD and 12,345 non-COPD) from a single centre between January 1995 and August 2008 were subjected to retrospective cross-sectional analysis. COPD patients were identified by ICD – 9 diagnostic codes and did possess significantly more manifestations of CVD, including heart failure, than the control group. Unfortunately preoperative lung function data was only available in 60% of the COPD group.