Abstract Body:
Background
Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality and frequently coexists with coronary artery disease (CAD). Both share risk factors including smoking, advanced age, and systemic inflammation. In patients with CAD, revascularization with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) is often required. However, factors influencing PCI versus CABG selection in patients with COPD, and the associated clinical contexts, remain incompletely understood.
Methods
We conducted a retrospective cohort study using the National Inpatient Sample (NIS) from 2016–2022 including COPD hospitalizations undergoing coronary revascularization. Procedures were classified as PCI or CABG. Survey-weighted analyses generated national estimates. Multivariable regression assessed associations between revascularization strategy and outcomes, including in-hospital mortality, length of stay (LOS), and total charges, adjusting for demographic, hospital, and clinical factors. Additional models evaluated predictors of PCI versus CABG selection, and stratified analyses assessed outcomes across subgroups.
Results
PCI was more likely among patients with prior CABG (aOR ~4.19), emergency department presentation (~3-fold higher odds), frailty/dementia (aOR ~2.4), acute myocardial infarction, female sex (aOR ~1.72), renal failure, pulmonary hypertension, and prior PCI. Lower odds of PCI were observed with coagulopathy, elective admission, complex coronary disease proxies, ECMO, and higher comorbidity burden.
In stratified analyses, PCI was associated with lower in-hospital mortality in several groups, including elective admissions (aOR 0.65), non-elective admissions (aOR 0.87), female patients (aOR 0.66), Medicare patients (aOR 0.70), and those treated at small or medium hospitals. Most other strata showed no significant mortality difference. In self-pay patients, PCI was associated with higher mortality (aOR 2.30).
PCI was consistently associated with shorter LOS and lower total charges across nearly all subgroups.
Conclusions
Among COPD hospitalizations undergoing coronary revascularization, PCI was more frequently selected in older, frailer, and acutely presenting patients and was associated with lower resource utilization and similar or lower mortality across most subgroups.