ECG-based risk factors for adverse cardiopulmonary events and treatment outcomes in COPD

Background COPD has high mortality, compounded by comorbid cardiovascular disease. We investigated two electrocardiogram (ECG) markers, Cardiac Infarction Injury Score (CIIS) and P pulmonale, as prognostic tools for adverse cardiopulmonary events in COPD. Methods Post hoc analysis of the IMPACT trial. Outcomes included odds (odds ratio [95% confidence intervals]) of adverse cardiopulmonary events stratified by CIIS threshold (<20/≥20) and P pulmonale (baseline). Events included all-cause death, hospitalisation/death, cardiovascular adverse event of special interest (CVAESI), severe COPD exacerbations, and moderate/severe COPD exacerbations. Effects of fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) versus FF/VI or UMEC/VI based on CIIS and P pulmonale were also assessed. Results We included 9448 patients. Patients with CIIS ≥20 had greater odds of all-cause death (1.73[1.27–2.37]; p <0.001), hospitalisation/death (1.33[1.17–1.50]; p <0.001), CVAESI (1.27[1.08–1.48]; p <0.005), severe COPD exacerbations (1.41[1.21–1.64]; p <0.001) and moderate/severe COPD exacerbations (1.25[1.13–1.40]; p <0.001) versus CIIS <20. Patients with P pulmonale ( versus without) had greater odds of all-cause death (2.25[1.54–3.29]; p <0.001), hospitalisation/death (1.51[1.28–1.79]; p <0.001), severe COPD exacerbations (2.00[1.65–2.41]; p <0.001) and moderate/severe COPD exacerbations (1.25[1.08–1.46]; p <0.001). A combined model demonstrated patients with CIIS ≥20 and P pulmonale had increased risk of all-cause death (3.38[1.23–9.30]; p=0.019), hospitalisation/death (1.61[1.14–2.22]; p=0.004), and rate of severe COPD exacerbations (1.89[1.22–2.91]; p=0.004) and moderate/severe COPD exacerbations (1.25[1.00–1.56]; p=0.046). The risk of all-cause death and CVAESI was reduced with FF/UMEC/VI versus UMEC/VI in patients with CIIS ≥20, but not CIIS <20. Conclusions These findings suggest potential clinical relevance of CIIS and P pulmonale as risk indicators for adverse cardiopulmonary events in COPD.