Chronic Obstructive Pulmonary Disease as an Independent Predictor of Left Main Coronary Artery Disease

<b>Background:</b> Chronic obstructive pulmonary disease (COPD) is increasingly recognized as a disorder linked to increased cardiovascular risk, often coexisting with coronary artery disease (CAD), yet angiographic data on coronary involvement in COPD remain limited. This study aimed to evaluate whether COPD is associated with a distinct angiographic pattern of CAD, focusing on vessel distribution. <b>Methods:</b> We retrospectively enrolled 94 patients who underwent coronary angiography between 2023 and 2024 for suspected or known CAD. Clinical data, comorbidities, laboratory testing, pulmonary function, electrocardiography, echocardiography, and angiography were collected. Participants were stratified into two groups: COPD (<i>n</i> = 47) and non-COPD (<i>n</i> = 47). Coronary vessels were classified by number, location, and diameter. The normality of continuous variables was assessed using the Shapiro-Wilk test. Non-normally distributed variables were compared using the Mann-Whitney U test, while Fisher's exact test was used for categorical comparisons. A multivariable logistic regression model was performed to identify independent predictors of left main coronary artery (LMCA) disease at the patient level. The primary endpoint was the association between COPD and CAD severity. <b>Results:</b> Baseline characteristics, including age, sex, BMI, and smoking history, were comparable between groups. The overall extent of CAD, expressed as the number of diseased vessels, did not differ significantly (<i>p</i> = 0.1436). However, vessel-based analysis revealed a distinct pattern: COPD patients showed a significantly higher prevalence of left main coronary artery (LMCA) disease compared to non-COPD patients (14% vs. 4.7%, <i>p</i> < 0.001). At the patient level, LMCA disease was present in 15/47 (31.9%) COPD patients compared with 6/47 (12.8%) non-COPD patients (<i>p</i> = 0.046). Multivariable logistic regression confirmed that COPD was an independent predictor of LMCA disease (OR = 3.56, 95% CI: 1.12-11.29, <i>p</i> = 0.031) after adjustment for age, sex, smoking, diabetes, and chronic kidney disease. Intermediate-caliber vessels were most frequently affected in both groups, while small-caliber branches were less commonly involved in COPD patients. <b>Conclusions</b>: COPD is an independent predictor of LMCA disease despite a similar overall angiographic extent of CAD. These findings suggest a distinct, high-risk coronary phenotype in COPD and highlight the need for enhanced cardiovascular vigilance and integrated cardiopulmonary management in this population.