Role Of Obstructive Sleep Apnea In Patients With Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention

Background and aim: Sleep apnea, including central sleep apnea(CSA), mixed sleep apnea(MSA), and the most common obstructive sleep apnea, is one the major health threats. Recent investigations revealed that OSA, an independent risk factor for coronary heart disease(CHD), is associated with poor prognosis. Amelioration of OSA improves clinical outcomes in CHD patients. In this light, we carried out this single center study to explore the prevalence and prognostic value of OSA inpatient with acute myocardial infarction(AMI) undergoing percutaneous coronary intervention(PCI).Methods:One hundred and sixty-nine in patients with AMI from the second affiliated hospital of Soochow University were recruited in this study. All patients underwent PCI and were issued bedside portable sleep monitor to acquire data from overnight surveillance. Diagnosis of OSA was determined when apnea-hyperpnoea index is over 15.The major adverse cardiac and cerebrovascular events(MACCE), including cardiac death, non-fatal myocardial infarction, and target vessel revascularization, readmission for heart failure, recurrent angina and stroke, were recorded in a 12-month follow-up period.Results:1. In a total of 169 patients, 93 had AHI over 15 and 76 had AHI below 15. The incidence of OSA in AMI patients undergoing PCI was 55%.2. Analysis of clinical characteristics revealed that patients with OSA were older(54.2ut Oyears vs 51.1ut Oyears, P<0.05) and had higher body weight(71.3ht OSA vs 67.5ht OS,P<0.05)compared to those without OSA. No significant differences in body mass index(BMI), waist circumference, and prevalence of hypertension were found between OSA and non-OSA subjects..3. The severity of coronary artery lesions, as well as the results of PCI was similar between OSA and non-OSA subjects.4. Complete blood count, fasting blood glucose, serum lipid profile, renal function, and left ventricular ejection fraction(LVEF) were similar between OSA and non-OSA subjects.5. Patients with OSA had significantly increased MACCE rate compared to those without OSA(12.9% vs 3.9%, P<0.05).Kaplan-Meier analysis with log-rank test showed that patients with OSA had decreased MACCE-free survival(P<0.05) compared to those without OSA. Further Cox regression analysis indicated that hypertension(adjusted hazard ratio(AOR) =4.255, 95%CI: 1.193-15.152, P=0.026), age(AOR=1.048, 95% CI: 1.001-1.097, P=0.046), and BMI(AOR=1.132, 95% CI:1.002-1.295, P=0.044) were independent predictors of MACCEs. In addition, AMI patients with OSA exhibited higher MACCE rate after PCI than those without OSA(AOR=2.556, 95% CI: 0.717-9.117, P<0.05).Conclusion:OSA is prevalent in patients with AMI undergoing PCI, especially in those with older age and higher body weight. The comorbidity of OSA is associated with increased MACCE rate and worse prognosis after PCI.