The risk of adverse coronary events is higher in patients with severe obstructive sleep apnea following percutaneous coronary intervention
Adil A, Pandey B, Mengesha T, et al. The Risk Of Adverse Coronary Events Is Higher In Patients With Severe Obstructive Sleep Apnea Following Percutaneous Coronary Intervention. Journal of the American College of Cardiology. 2017;69(11):1236. doi:10.1016/s0735-1097(17)34625-9.
BACKGROUND: Limited data is available on the impact of obstructive sleep apnea (OSA) or continuous positive airway pressure (CPAP) therapy on coronary events or mortality in patients undergoing percutaneous coronary intervention (PCI).
METHODS: From a multispecialty community sleep center, patients undergoing polysomnography (PSG) from 2011 to 2014 were identified. Of these, those who had PCI performed after PSG were included in this analysis. Coronary events (myocardial infarction or redo PCI), mortality or composite endpoint (MI, redo PCI and death) after PCI was compared between those with severe OSA (apnea-hypopnea index [AHI] 330) or non-severe OSA (AHI<30) using Wilcoxon, Chi square test, and Kaplan-Meier analysis. Predictors of composite and individual end points were determined using proportional hazard cox model.
RESULTS: The cohort consisted of 222 patients (mean age 63.2±11.3 years, 70% male) of whom 39% had severe OSA, 24% moderate OSA, 28 mild OSA and 9% had no OSA. The composite endpoint after PCI was significantly higher in those with severe OSA, compared to those with non-severe OSA (36% vs 24%, hazard ratio: 1.8, 95% CI: 1.1-2.9; p-value: 0.02, Fig). Multivariate analysis showed severity of OSA, MI and age>65 as independent predictors for composite endpoints. (Fig)
CONCLUSIONS: Severe OSA has a negative impact on coronary event rate after PCI. Whether treating OSA with CPAP therapy helps reduce these events needs to be further investigated.