Impact of chronic obstructive pulmonary disease on patients with aortic aneurysms: a nationwide retrospective cohort study in Taiwan

OBJECTIVES: Aortic aneurysm (AA) is a leading cause of death worldwide. Chronic obstructive pulmonary disease (COPD) is a risk factor for AA, and the prognoses of COPD patients with AA who underwent/did not undergo an operation warrant investigation. DESIGN: A nationwide retrospective cohort study. SETTING: We included patients with AA older than 18 years who received their first AA diagnosis between 2005 and 2011 in Taiwan. PARTICIPANTS: This study enrolled 3263 COPD patients with AA before propensity score matching and 2127 COPD patients with AA after propensity score matching. OUTCOME MEASURES: The main outcomes were all-cause mortality and rehospitalisation for AA or operation. The outcomes of COPD patients with AA and COPD patients without AA during an 8-year follow-up period were examined using Cox proportional hazards models. RESULTS: In the AA population, patients with COPD showed higher rates of mortality and rehospitalisation than patients without COPD with adjusted HRs of 1.12 (95% CI 1.03 to 1.22) and 1.11 (95% CI 1.01 to 1.23), respectively, after propensity score matching. Analysis of the patients who underwent an operation revealed that the rates of mortality of COPD and non-COPD patients were not significantly different. In contrast, among the patients who did not receive an operation, patients with COPD showed a higher mortality rate than patients without COPD with an adjusted HR of 1.11 (95% CI 1.0 to 1.22). CONCLUSIONS: The outcomes of COPD patients with AA undergoing an operation were improved, but the mortality rate of non-COPD patients with AA remained high. An effective treatment to reduce mortality in this group warrants further investigation.