What is the clinical evidence from this study?

Study design: Cohort. Population: Coronary Artery Disease requiring CABG (n=4801). Intervention: Chronic obstructive pulmonary disease (COPD) vs. No COPD. Primary outcome: Long-term mortality (HR 1.9, 95% CI 1.6-2.2, p=<0.0001).

January 1, 2013Frontiers in Public Health18 citationsOpen Access

The Effect of Race and Chronic Obstructive Pulmonary Disease on Long-Term Survival after Coronary Artery Bypass Grafting

Q: What are the key findings of this study?

Chronic obstructive pulmonary disease significantly decreased long-term survival after coronary artery bypass grafting (adjusted HR 1.9), with no survival disadvantage observed for black patients compared to white patients.

JEJimmy T. Efird WOWesley T. O’Neal CACurtis A. Anderson

Key Result

Chronic obstructive pulmonary disease significantly decreased long-term survival after coronary artery bypass grafting (adjusted HR 1.9), with no survival disadvantage observed for black patients compared to white patients.

Study Design

Type

Cohort (n=4,801)

Multicenter

Structured PICO

Does the presence of COPD affect long-term survival after CABG differently in black versus white patients?

Population

4,801 black and white patients undergoing first-time, isolated CABG, followed for a median of 4.4 years to assess the impact of COPD and race on long-term survival.

Exposure

Presence of chronic obstructive pulmonary disease (COPD), stratified by race (black vs. white)

Comparator

Absence of COPD

Outcome

Long-term survival (any cause of death postoperatively) at median 4.4 years follow-uphard clinical

COPD is a significant predictor of decreased long-term survival after CABG, but contrary to general population trends, black patients with COPD did not exhibit a worse survival disadvantage compared to white patients with COPD.

Main Result

Hazard Ratio: 1.9 (95% CI 1.6–2.2)

Absolute Event Rate: 73% vs 87%

p-value: p=<0.0001

Limitations

Retrospective design susceptible to unmeasured confounding, recall, and selection bias.
Pulmonary function tests were not repeated prior to surgery, potentially leading to misclassification of COPD status.
Unable to stratify analyses by COPD severity and race due to a limited number of patients.
Socioeconomic position, education, and income were not collected.
Cause of death was not recorded in the National Death Index, so mortality may have been unrelated to COPD.
Retrospective design susceptible to recall and selection bias
Association between COPD and poor survival may be non-causal (e.g., due to non-cardiac causes)
Few patients at-risk after year 6, making later probability estimates unreliable
Pulmonary function tests not repeated prior to surgery, risking misclassification of COPD status
Socioeconomic position, education, income, and payor status were not collected

Abstract

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a known predictor of decreased long-term survival after coronary artery bypass grafting (CABG). Differences in survival by race have not been examined. METHODS: A retrospective cohort study was conducted of CABG patients between 2002 and 2011. Long-term survival was compared in patients with and without COPD and stratified by race. Hazard ratios (HR) and 95% confidence intervals (CI) were computed using a Cox regression model. RESULTS: = 4,801).The median follow-up for study participants was 4.4 years. COPD was observed to be a statistically significant predictor of decreased survival independent of race following CABG (no COPD: HR = 1.0; white COPD: adjusted HR = 1.9, 95% CI = 1.7-2.3; black COPD: adjusted HR = 1.6, 95% CI = 1.1-2.2). CONCLUSION: Contrary to the expected increased risk of mortality among black COPD patients in the general population, a similar survival disadvantage was not observed in our CABG population.

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