Exacerbations of chronic obstructive pulmonary disease and coronary atherosclerosis

Abstract

Objective: to determine the characteristics of coronary lesions in patients with chronic obstructive pulmonary disease (COPD), depending on the /frequent exacerbations in medical history. Methods: 110 patients with COPD, who suffered acute coronary syndrome, were included in cross-sectional study. Patients with /frequent exacerbations of COPD was /formed into the group (n - 24). As controls, was /formed the group without a history of /frequent exacerbations (n = 86). In both groups was assessed the /prevalence and severity of coronary atherosclerosis by invasive coronary angiography. One month after discharge /from the hospital in nonacute period of COPD we determined in both groups the level of C-reactive/protein (CRP) in the blood. Results: traditional assessment of the severity of coronary lesions by separation on a one-, two-, and three-vessel disease significant differences were not/found between the groups. At the same time, the total number of all stenosis, hemodynamically significant stenosis and occlusions/ critical stenosis on the average was higher in the group with frequent exacerbations: by 26% (p = 0,002), 37% (p = 0,003) and 47% (p = 0,024) respectively. The main cause /for these differences were hemodynamically significant stenosis of the major coronary arteries in the proximal and distal segments (the difference between the groups 31% and 87%, respectively, p = 0,041 andp = 0,024), and stenosis of secondary branches (54% difference, p = 0,023). In the group with frequent exacerbations of COPD level of CRP was higher than control group (3,36 [2,32; 5,10] vs 2,32 [1,70; 3,27]; p = 0,017). The correlation between SYNTAX score and CRP level (r= 0,29; p < 0,01 ), between the total number of all stenosis and CRP (r= 0,36; p <0,001), and between the total number of all stenosis of the major coronary arteries and CRP (r= 0,36; p < 0,001) was /found. Conclusion: phenotype of COPD with frequent exacerbations is associated with more severe coronary ™ atherosclerosis, probably due to chronic /persistent inflammation.