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Published on: December 6, 2016
Obstructive Sleep Apnea and Cardiovascular Events After Percutaneous Coronary Intervention
Chi-Hang Lee1, Rishi Sethi2, Ruogu Li2
1From Department of Cardiology, National University Heart Centre, Singapore (C-H.L., G.L., C.-Y.K., P.-F.C., M.Y.C., A.M.R., H.-C.T.); Department of Cardiology, King George's Medical University, Lucknow, India (R.S., S.C., A.M., R.B.K.); Department of Cardiology, Shanghai Chest Hospital, China (R.L., X.-X.Y., W.-W.Z.); Department of Cardiology, Tan Tock Seng Hospital, Singapore (H.-H.H.); No (1) 1000-Bed Defence Services General Hospital, Mingaladon, Yangon, Myanmar (T.H.); Cardiac Medical Unit, Grantham Hospital, Hong Kong (M.-H.J.); Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, China (X.-F.G., Z.G., S.-L.C., J.-J.Z.); Hypertension Unit-Heart Institute (InCor), University of Sao Paulo Medical School, Brazil (S.F.F., C.H.G.U., L.F.D.); Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore (T.-H.O.); Sleep Educators, Antioch, CA (G.R.); and Saw Swee Hock School of Public Health, National University of Singapore, Singapore (B.-C.T.). mdclchr@nus.edu.sg.
Insights
Obstructive sleep apnea (OSA) is linked to more cardiac events after stenting. This study found OSA independently predicts major adverse cardiac and cerebrovascular events (MACCEs) in patients undergoing percutaneous coronary intervention.
Area of Science:
- Cardiology
- Sleep Medicine
- Clinical Research
Background:
- Limited data exists on obstructive sleep apnea (OSA) prognostic significance in coronary artery disease patients.
- A hypothesis was formed that OSA predicts major adverse cardiac and cerebrovascular events (MACCEs) in patients undergoing percutaneous coronary intervention (PCI).
Purpose of the Study:
- To investigate the prognostic value of OSA in patients with coronary artery disease undergoing PCI.
- To determine if OSA is an independent predictor of MACCEs in this patient population.
Main Methods:
- A prospective, multicenter registry (Sleep and Stent Study) enrolled 1311 patients post-PCI.
- Patients underwent sleep studies within 7 days of PCI; OSA was defined as an apnea-hypopnea index ≥15 events/hour.
- MACCEs (composite of cardiovascular mortality, MI, stroke, revascularization) were tracked over a median follow-up of 1.9 years.
Main Results:
- Obstructive sleep apnea (OSA) was present in 45.3% of the study cohort.
- The incidence of MACCEs was significantly higher in patients with OSA compared to those without (3-year estimate: 18.9% vs. 14.0%, p=0.001).
- Multivariate analysis revealed OSA as an independent predictor of MACCEs (adjusted hazard ratio: 1.57; 95% CI: 1.10-2.24; P=0.013).
Conclusions:
- Obstructive sleep apnea (OSA) is independently associated with an increased risk of subsequent MACCEs in patients following percutaneous coronary intervention.
- Further research into therapeutic strategies to mitigate OSA-related risks in PCI patients is warranted.
Background:
There is a paucity of data from large cohort studies examining the prognostic significance of obstructive sleep apnea (OSA) in patients with coronary artery disease. We hypothesized that OSA predicts subsequent major adverse cardiac and cerebrovascular events (MACCEs) in patients undergoing percutaneous coronary intervention.
Methods And Results:
The Sleep and Stent Study was a prospective, multicenter registry of patients successfully treated with percutaneous coronary intervention in 5 countries. Between December 2011 and April 2014, 1748 eligible patients were prospectively enrolled. The 1311 patients who completed a sleep study within 7 days of percutaneous coronary intervention formed the cohort for this analysis. Drug-eluting stents were used in 80.1% and bioresorbable vascular scaffolds in 6.3% of the patients, and OSA, defined as an apnea-hypopnea index of ≥15 events per hour, was found in 45.3%. MACCEs, a composite of cardiovascular mortality, nonfatal myocardial infarction, nonfatal stroke, and unplanned revascularization, occurred in 141 patients during the median follow-up of 1.9 years (interquartile range, 0.8 years). The crude incidence of an MACCEs was higher in the OSA than the non-OSA group (3-year estimate, 18.9% versus 14.0%; p=0.001). Multivariate Cox regression analysis indicated that OSA was a predictor of MACCEs, with an adjusted hazard ratio of 1.57 (95% confidence interval, 1.10-2.24; P=0.013), independently of age, sex, ethnicity, body mass index, diabetes mellitus, and hypertension.
Conclusions:
OSA is independently associated with subsequent MACCEs in patients undergoing percutaneous coronary intervention. Evaluation of therapeutic approaches to mitigate OSA-associated risk is warranted.
Clinical Trial Registration:
URL: http://www.clinicaltrials.gov. Unique identifier: NCT01306526.
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