A75-12 Longitudinal Progression of Ct-Quantified Emphysema as a Predictor of Incident Coronary Artery Disease and Mortality in COPD: A Retrospective Cohort Study

Background

In chronic obstructive pulmonary disease (COPD), CT-quantified emphysema is a central marker for monitoring disease progression. Coronary artery disease (CAD) is a leading cause of death in COPD. Whether the progression of emphysema predicts new-onset CAD and mortality is unknown. We aimed to characterize long-term emphysema trajectories based on coronary artery disease and to evaluate the relationship between these longitudinal emphysema profiles and subsequent clinical events.

Methods

In this retrospective cohort study, we enrolled 339 COPD patients without CAD, who underwent 1,112 serial chest CT scans over a follow-up of up to 120 months. Emphysema was automatically quantified as the percentage of lung volume below −950 HU. Emphysema trajectories were modeled using a generalized additive mixed model (GAMM), and the joint model was applied to assess the association between longitudinal emphysema changes and incident of CAD and all-cause mortality.

Results

Among 339 patients with COPD, 149 all-cause deaths occurred during follow-up. GAMM analysis revealed a significant interaction between time and CAD groups (Pinteraction < 0.001), with markedly different emphysema trajectories between groups: CAD groups showed a initial elevation (β = 0.070), whereas non-CAD group exhibited minimal elevation (β = 0.032). During the whole period, emphysema levels showed significantly different trajectories in groups (Pinteraction = 0.041). In joint model, each 1% annual increase in emphysema volume fraction was independently associated with higher risks of incident CAD (HR = 1.18, 95% CI: 1.02-1.69; p = 0.010) and all-cause mortality (HR = 1.05, 95% CI: 1.02-1.10; p = 0.002).

Conclusion

Longitudinal progression of CT-quantified emphysema independently predicts incident CAD and mortality in COPD. Monitoring emphysema progression may improve cardiovascular risk stratification and long-term prognosis in these patients.

This abstract is funded by: This study was supported by the National Key Research and Development Program of China grants 2016YFC1304000 (C Chen); The National Natural Scientific Foundation of China 82170017,82370085(C Chen); Zhejiang Provincial Key Research and Development Program 2020C03067 (C Chen)