ECG-based risk factors for adverse cardiopulmonary events and treatment outcomes in COPD
R. Chad Wade, Fernando J. Martinez, Gerard J. Criner, Lee Tombs, David A. Lipson, David Halpin, MeiLan K. Han, Dave Singh, Robert A. Wise, Ravi Kalhan, Mark T. Dransfield
Abstract
Background COPD has high mortality, compounded by comorbid cardiovascular disease. We investigated two ECG markers, Cardiac Infarction Injury Score (CIIS) and P pulmonale, as prognostic tools for adverse cardiopulmonary events in COPD. Methods This was a p ost hoc analysis of the IMPACT trial. Outcomes included odds (odds ratio, 95% confidence intervals) of adverse cardiopulmonary events stratified by CIIS threshold (<20 versus ≥20) and P pulmonale (baseline). Events included all-cause death, hospitalisation or death, cardiovascular adverse event of special interest, severe COPD exacerbations, and moderate/severe COPD exacerbations. We also assessed the effects of fluticasone furoate/umeclidinium/vilanterol versus fluticasone furoate/vilanterol or umeclidinium/vilanterol based on CIIS and P pulmonale. Results We included 9448 patients. Patients with CIIS ≥20 ( versus CIIS <20) had greater odds of all-cause death (OR 1.73, 95% CI 1.27–2.37, p<0.001), hospitalisation or death (OR 1.33, 95% CI 1.17–1.50, p<0.001), cardiovascular adverse event of special interest (OR 1.27, 95% CI 1.08–1.48, p<0.005), severe COPD exacerbations (OR 1.41, 95% CI 1.21–1.64, p<0.001) and moderate/severe COPD exacerbations (OR 1.25, 95% CI 1.13–1.40, p<0.001). Patients with P pulmonale ( versus without) had greater odds of all-cause death (OR 2.25, 95% CI 1.54–3.29, p<0.001), hospitalisation or death (OR 1.51, 95% CI 1.28–1.79, p<0.001), severe COPD exacerbations (OR 2.00, 95% CI 1.65–2.41, p<0.001) and moderate/severe COPD exacerbations (OR 1.25, 95% CI 1.08–1.46, p<0.001). A combined model demonstrated that patients with CIIS ≥20 and P pulmonale had increased risk of all-cause death (OR 3.38, 95% CI 1.23–9.30, p=0.019), hospitalisation or death (OR 1.61, 95% CI 1.14–2.22, p=0.004) and rate of severe COPD exacerbations (OR 1.89, 95% CI 1.22–2.91, p=0.004) and moderate/severe COPD exacerbations (OR 1.25, 95% CI 1.00–1.56, p=0.046). The risk of all-cause death and cardiovascular adverse events of special interest was reduced with fluticasone furoate/umeclidinium/vilanterol versus umeclidinium/vilanterol in patients with CIIS ≥20, but not CIIS <20. Conclusions These findings suggest the potential clinical relevance of CIIS and P pulmonale as risk indicators for adverse cardiopulmonary events in COPD.