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Current symptom-based risk scores for stable coronary artery disease evaluation are not applicable in COPD patients

Christoph Beyer, Alex Pizzini, Anna Boehm, Judith Loeffler-Ragg, Guenter Weiss, Gudrun Feuchtner, Axel Bauer, Guy Friedrich, Fabian Plank
ERJ Open Research 2020 6: 00492-2020; DOI: 10.1183/23120541.00492-2020
Christoph Beyer
1Dept of Internal Medicine III – Cardiology and Angiology, Medical University Innsbruck, Innsbruck, Austria
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Alex Pizzini
2Dept of Internal Medicine II – Infectious Diseases, Pneumology and Rheumatology, Medical University Innsbruck, Innsbruck, Austria
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  • ORCID record for Alex Pizzini
Anna Boehm
2Dept of Internal Medicine II – Infectious Diseases, Pneumology and Rheumatology, Medical University Innsbruck, Innsbruck, Austria
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  • ORCID record for Anna Boehm
Judith Loeffler-Ragg
2Dept of Internal Medicine II – Infectious Diseases, Pneumology and Rheumatology, Medical University Innsbruck, Innsbruck, Austria
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Guenter Weiss
2Dept of Internal Medicine II – Infectious Diseases, Pneumology and Rheumatology, Medical University Innsbruck, Innsbruck, Austria
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Gudrun Feuchtner
3Dept of Radiology, Medical University Innsbruck, Innsbruck, Austria
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Axel Bauer
1Dept of Internal Medicine III – Cardiology and Angiology, Medical University Innsbruck, Innsbruck, Austria
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Guy Friedrich
1Dept of Internal Medicine III – Cardiology and Angiology, Medical University Innsbruck, Innsbruck, Austria
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Fabian Plank
1Dept of Internal Medicine III – Cardiology and Angiology, Medical University Innsbruck, Innsbruck, Austria
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  • ORCID record for Fabian Plank
  • For correspondence: fabian.plank@i-med.ac.at
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  • FIGURE 1
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    FIGURE 1

    Flowchart depicting patient inclusion. CABG: coronary artery bypass graft; CAD: coronary artery disease; ICA: invasive coronary angiography; MI: myocardial infarction; PCI: percutaneous coronary intervention.

  • FIGURE 2
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    FIGURE 2

    Pretest probabilities according to modified Diamond–Forrester (ESC 2019) for control and COPD Global Initiative for Chronic Obstructive Lung Disease (GOLD) 1 to 4. ns: not significant.

Tables

  • Figures
  • TABLE 1

    Study population

    ControlCOPDp-value
    Subjects n302302
    Female98 (32.5)85 (28.2)0.29
    Age years66.2±8.266.3±8.20.99
    BMI27.7±4.426.7±6.00.29
    Arterial hypertension239 (79.1)231 (76.5)0.49
    Dyslipidaemia185 (61.3)185 (61.3)1.00
    Diabetes50 (16.6)51 (16.9)1.00
    Smoking258 (85.4)259 (85.8)1.00
    Family history of CAD45 (14.9)45 (14.9)1.00
    PAD22 (7.3)14 (4.6)0.22
    CKD (≥3b)4 (1.3)6 (2.0)0.75
    ASS180 (59.6)198 (65.6)0.19
    Statin150 (49.7)139 (46.0)0.33
    Ezetimibe6 (2.0)6 (2.0)1.00
    β-blocker89 (29.5)93 (30.8)0.81
    ACE inhibitor76 (25.2)97 (32.1)0.07
    AT2 channel blocker71 (23.5)59 (19.5)0.20
    Calcium channel blocker46 (15.2)44 (14.6)0.82
    Diuretic82 (27.2)98 (32.5)0.18
    COPD (GOLD) 134 (11.3)
    COPD (GOLD) 2120 (39.7)
    COPD (GOLD) 398 (32.5)
    COPD (GOLD) 450 (16.6)

    Data are presented as n (%) or mean±sd, unless otherwise stated. BMI: body mass index; CAD: coronary artery disease; PAD: peripheral artery disease; CKD: chronic kidney disease; ASS: aspirin salicylic acid; ACE: angiotensin-converting enzyme; GOLD: Global Initiative for Chronic Obstructive Lung Disease.

    • TABLE 2

      Symptoms and outcome

      ControlCOPDp-value
      Subjects n302302
      Typical chest pain115 (38.1)76 (25.2)0.0009
      Atypical chest pain43 (14.2)78 (25.8)0.0005
      Non-anginal chest pain 63 (20.9)93 (30.8)0.0069
      Dyspnoea only81 (26.8)55 (18.2)0.015
      CCS
       081 (26.8)55 (18.2)0.015
       156 (18.5)9 (3.0)<0.0001
       270 (23.2)67 (22.2)0.85
       334 (11.3)81 (26.8)<0.0001
       461 (20.2)90 (29.8)0.0084
      NYHA
       1129 (42.7)60 (19.9)<0.0001
       2139 (46.0)93 (30.8)0.0002
       328 (9.3)121 (40.1)<0.0001
       46 (2.0)28 (9.3)<0.0001
      Delay between symptoms and ICA months8.3±12.719.9±22.0<0.0001
      ICA
       Negative (no stenosis)128 (42.4)139 (46.0)0.41
       <50% stenosis14 (4.6)24 (8.0)0.13
       50–70% stenosis36 (11.9)50 (16.6)0.13
       >70% stenosis113 (37.4)79 (26.2)0.0039
       100% stenosis11 (3.6)10 (3.3)1.00
      Revascularisation (PCI, CABG)118 (39.1)94 (31.1)0.050
      Follow-up months38.4±39.538.4±39.00.94
      MACE4 (1.3)18 (6.0)0.004
      Cardiovascular death2 (0.7)11 (3.6)0.02
      All-cause death6 (2.0)16 (5.3)0.05

      Data are presented as n (%) or mean±sd, unless otherwise stated. CCS: Canadian Cardiovascular Society grading scale; NYHA: New York Heart Association grading scale; ICA: invasive coronary angiography; PCI: percutaneous coronary intervention; CABG: coronary artery bypass graft; MACE: major adverse cardiovascular events. Bold text indicates statistical significance.

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      Vol 6 Issue 4 Table of Contents
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      Current symptom-based risk scores for stable coronary artery disease evaluation are not applicable in COPD patients
      Christoph Beyer, Alex Pizzini, Anna Boehm, Judith Loeffler-Ragg, Guenter Weiss, Gudrun Feuchtner, Axel Bauer, Guy Friedrich, Fabian Plank
      ERJ Open Research Oct 2020, 6 (4) 00492-2020; DOI: 10.1183/23120541.00492-2020

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      Current symptom-based risk scores for stable coronary artery disease evaluation are not applicable in COPD patients
      Christoph Beyer, Alex Pizzini, Anna Boehm, Judith Loeffler-Ragg, Guenter Weiss, Gudrun Feuchtner, Axel Bauer, Guy Friedrich, Fabian Plank
      ERJ Open Research Oct 2020, 6 (4) 00492-2020; DOI: 10.1183/23120541.00492-2020
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