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.

中文翻译：

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COPD 不良心肺事件和治疗结果的基于心电图的危险因素。


背景 COPD 死亡率高，并伴有心血管疾病。我们研究了两个心电图标志物，心脏梗死损伤评分 （CIIS） 和肺肺 P，作为 COPD 不良心肺事件的预后工具。方法 这是对 IMPACT 试验的 P ost 特别分析。结局包括按 CIIS 阈值 （<20 对 ≥20） 和肺 P （基线） 分层的不良心肺事件的比值 （比值比、95% 置信区间）。事件包括全因死亡、住院或死亡、特别关注的心血管不良事件、严重 COPD 恶化和中度/重度 COPD 恶化。我们还评估了糠酸氟替卡松/乌美溴铵/维兰特罗与糠酸氟替卡松/维兰特罗或乌美溴铵/维兰特罗基于 CIIS 和肺 P 的效果。结果 我们纳入了 9448 例患者。CIIS ≥20（与 CIIS <20 相比）患者全因死亡（OR 1.73,95% CI 1.27-2.37，p<0.001）、住院或死亡（OR 1.33,95% CI 1.17-1.50，p<0.001）、特别关注的心血管不良事件（OR 1.27,95% CI 1.08-1.48，p<0.005）、严重 COPD 恶化（OR 1.41,95% CI 1.21-1.64，p<0.001）和中度/重度 COPD 恶化（OR 1.25，p<0.001）的几率更高。 95% CI 1.13-1.40，p<0.001）。肺肺单胞菌患者（与无肺肺单胞菌相比）全因死亡（OR 2.25,95% CI 1.54-3.29，p<0.001）、住院或死亡（OR 1.51,95% CI 1.28-1.79，p<0.001）、严重 COPD 恶化（OR 2.00,95% CI 1.65-2.41，p<0.001）和中度/重度 COPD 恶化（OR 1.25,95% CI 1.08-1.46，p<0.001）的几率更高。一个联合模型表明，CIIS ≥20 和肺肺 P 患者全因死亡 （OR 3.38,95% CI 1.23-9.30，p=0.019）、住院或死亡 （OR 1.61,95% CI 1.14-2.22，p=0.004）和重度 COPD 恶化率 （OR 1.89,95% CI 1.22-2.91，p=0.004） 和中度/重度 COPD 恶化 （OR 1.25,95% CI 1.00-1.56，p=0.046）。在 CIIS ≥20 患者中，糠酸氟替卡松/乌美溴铵/维兰特罗降低全因死亡和特别关注的心血管不良事件的风险，但 CIIS <20 未降低。结论 这些发现表明 CIIS 和肺 P 作为 COPD 不良心肺事件的风险指标具有潜在的临床相关性。