Prognostic factors of mortality and cardiovascular outcomes in the tiotropium safety and performance in respimat (TIOSPIR) trial

Background: Cardiovascular (CV) comorbidities in chronic obstructive pulmonary disease (COPD) patients are frequent. We evaluated whether baseline variables can predict mortality and CV events in the TIOSPIR trial (17,116 COPD patients receiving tiotropium Respimat 5 or 2.5µg or HandiHaler 18µg for a mean of 2.3 yrs). Methods: Exploratory pooled analysis from TIOSPIR to determine prognostic factors for mortality, major adverse CV event (MACE), fatal MACE, myocardial infarction and stroke outcomes was performed. Results: Patients with the following characteristics had higher risk of death and/or CV event during the study period: Male, age ≥70 yrs, low FEV1, breathlessness (MMRC≥2), CV medication use and history of CV events (ischemic heart disease [IHD], cardiac arrhythmia), or exacerbation in the last year (table). View this table: Table: Unadjusted risk ratio (RR) by baseline characteristic for all-cause mortality/CV events Conclusions: In TIOSPIR, prognostic factors for CV and all-cause mortality were similar, with greater risk for CV events in patients with CV medication or history (particularly IHD). High MMRC also particularly correlated with fatal CV events. Exacerbations were prognostic for both all-cause and CV death, but not for non-fatal CV events. Funded by Boehringer Ingelheim.