COPD Patients May Ultimately Benefit from CABG

Results of a longitudinal study suggest that certain patients with chronic obstructive pulmonary disease (COPD) may eventually benefit from coronary artery bypass grafting (CABG), Israeli researchers report in the January issue of Chest.

In a previous study, Dr. Benjamin Medalion from The Edith Wolfson Medical Center, Holon and colleagues showed that clinical COPD is associated with higher morbidity and mortality rates immediately after CABG and during the first postoperative year. In the current study, they assessed the impact of COPD on the long-term outcome of 74 patients undergoing CABG.

Over a mean of 8.6 years, survival was significantly better for the 37 COPD-free controls than for the 37 patients with clinical COPD. Actuarial survival at 9 years was 65% in the COPD group versus 92% in the control group.

A higher mortality rate was seen in COPD patients immediately after the operation and this increased continuously during the follow-up period. Of the 13 COPD patients who died, 2 did so in the early postoperative period, 3 died during mid-term follow-up (13.8 months), and 8 died during late follow-up (8.6 years). All three deaths in the control group were during late follow-up.

Arrhythmia was the major cause of death (62%) in COPD patients. In controls, there was one cardiac death, one from cancer and another from stroke.

Pulmonary function, which was mildly decreased in both groups at mid-term follow-up, had returned to baseline levels at late follow-up in the control group and had improved to significantly above baseline in the COPD group.

At mid-term follow-up, less than half of the surviving COPD patients felt they had improved their quality of life. However, on late follow-up, “all patients with COPD who survived believed they had a significantly improved quality of life compared to preoperative status,” say the investigators.

They conclude that this result, coupled with the finding that the long-term survival of COPD patients after CABG is “at least as good as” the natural history of isolated patients with COPD, suggests that the procedure carries “a beneficial long-term effect.”

Chest 2004;125:56-62.