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(Circulation. 2006;114:I-430 – I-434.)
© 2006 American Heart Association, Inc.

Surgery for Coronary Artery Disease

Long-Term Survival of Patients With Chronic Obstructive Pulmonary Disease Undergoing Coronary Artery Bypass Surgery

Bruce J. Leavitt, MD; Cathy S. Ross, MS; Brian Spence, MD; Stephen D. Surgenor, MD; Elaine M. Olmstead, BA; Robert A. Clough, MD; David C. Charlesworth, MD; Robert S. Kramer, MD; Gerald T. O’Connor, PhD, DSc, for the Northern New England Cardiovascular Disease Study Group

From the Fletcher Allen Health Care (B.J.L.), Burlington, VT; Dartmouth Medical School (C.S.R., E.M.O., D.S.L., G.T.O.), Hanover, NH; Dartmouth-Hitchcock Medical Center (S.D.S., B.S.), Lebanon, NH; Eastern Maine Medical Center (R.A.C.), Bangor, Me; Catholic Medical Center (D.C.C.), Manchester, NH; Maine Medical Center (R.S.K.), Portland, Me

Correspondence to Bruce J. Leavitt, MD, Fletcher Allen Health Care, 111 Colchester Ave, Burlington, VT 05401-1473. E-mail bruce.leavitt{at}vtmednet.org

Background— Chronic obstructive pulmonary disease (COPD) is associated with increased in-hospital mortality in patients undergoing coronary artery bypass surgery (CABG). Long-term survival is less well understood. The present study examined the effect of COPD on survival after CABG.

Methods and Results— We conducted a prospective study of 33 137 consecutive isolated CABG patients between 1992 and 2001 in northern New England. Records were linked to the National Death Index for long-term mortality data. Cox proportional hazards regression was used to calculate hazard ratios (HRs). Patients were stratified by: no comorbidities (none), COPD, COPD plus comorbidities, and other comorbidities with no COPD. There were 131 434 person years of follow-up and 5344 deaths. The overall incidence rate (deaths per 100 person years) was 4.1. By group, rates were: 2.1 (none), 4.0 (COPD alone), 5.5 (other), and 9.4 (COPD plus; log rank P<0.001). After adjustment, survival with COPD alone was worse compared with none (HR, 1.8; 95% CI, 1.6 to 2.1; P<0.001). Patients with other comorbidities compared with none had even worse survival (HR, 2.2; 95% CI, 2.1 to 2.4; P<0.001). Patients with COPD plus other comorbidities compared with none had the worst long-term survival (HR, 3.6; 95% CI, 3.3 to 3.9; P<0.001).

Conclusions— Patients with only COPD had significantly reduced long-term survival compared with patient with no comorbidities. Patients with COPD and 1 other comorbidity had the worst survival rate when compared with all of the other groups.

Key Words: survival • chronic obstructive pulmonary disease • revascularization • morbidity • surgery