Correlation Between Obstructive Sleep Apnea Hypopnea Syndrome And Prognosis In Patients With MINOCA

Part Ⅰ: Analysis of clinical features and predictive factors of Myocardial Infarction with Nonobstructive Coronary ArteriesObjective To investigate the clinical characteristics and prognostic factors of patients with Myocardial Infarction with Nonobstructive Coronary Arteries(MINOCA).Method Data of 1756 patients with percutaneous coronary intervention(PCI)were prospectively analyzed.According to the results of coronary angiography,stenosis<50% was Myocardial Infarction with Nonobstructive Coronary Arteries(MINOCA),>50% was obstructive myocardial infarction(MICAD).Gender,age,smoking history,hypertension history,diabetes history,hyperlipidemia and other general information of all included patients were collected.Laboratory data including troponin,creatinine,uric acid,N terminal B-type natriuretic peptide(NT-pro BNP),left ventricular ejection fraction and ECG ST segment changes were collected.All patients were assessed by berlin questionnaire(BQ).Clinical characteristics and incidence of obstructive sleep apnea hypopnea syndrome were analyzed and compared between the two groups.The predictive factors of MINOCA were analyzed by logistic multiple regression.Results The incidence of MINOCA was 7.3%.Compared with MICAD group,troponin,white blood cell count and ST segment elevation of ECG in MINOCA group were lower than those in MICAD group,while ST segment depression was higher than those in MICAD group(all P<0.01).Logistic regression analysis showed that the white blood cell count(P<0.01;OR=0.41;95%CI 0.30~0.67),troponin(P=0.018;OR=0.26;95%CI 0.15~0.82),ST segment depression(P<0.01;OR=2.90;95%CI 1.84~3.31),ECG ST segment elevation(P<0.01;OR=0.32;95%CI 0.13~0.86),OSAHS(P<0.05;OR=1.016;95%CI 1.002~1.032);In addition,Berlin questionnaire results of all patients showed that the incidence of OSAHS in MINOCA group was higher than that in MICAD group(P<0.01).Conclusion The main clinical characteristics and predictors of MINOCA include: no significant increase of troponin and white blood cell count,low ST segment of electrocardiogram,and increased incidence of OSAHS.Part Ⅱ Correlation between obstructive sleep apnea hypopnea syndrome and prognosis in patients with MINOCAObjective In this study,inpatients clinically diagnosed with coronary non-obstructive myocardial infarction(MINOCA)were subjected to Berlin questionnaire survey to monitor their night sleep,so as to explore the influence of obstructive sleep apnea hypopnea syndrome(OSAHS)on the prognosis of patients with MINOCA,providing new ideas for the treatment of patients with MINOCA.Methods A total of 155 MINOCA patients admitted to the Department of Cardiovascular Medicine of Jiaxing First Hospital from January 2018 to June 2021 were included.The patients completed the Berlin questionnaire and the night sleep monitoring by polynography during hospitalization.According to the results of Berlin questionnaire,the patients were divided into two groups,OSAHS group and nonOSAHS group.Baseline data were collected from both groups,including demographic data such as gender,age and body mass index of enrolled patients.And previous disease history,ECG ST segment changes,oral medication after discharge and other clinical data as well as N terminal pro-brain nitric peptide(NT-pro BNP),Troponin(Tn),C-reactive protein(CRP)and other laboratory test indicators.A follow-up period of 18 months was conducted to record the incidence of major unscrupulous cerebrovascular events(MACCE),such as re-hospitalization due to angina pectoris or heart failure,non-fatal ischemic stroke,non-fatal myocardial infarction,and cardiogenic death.Results There were 155 patients with MINOCA,including 41 patients in OSAHS group and 114 patients without OSAHS group.Compared with the control group,the OSAHS group had a higher proportion of males and smoking history,and there were no significant differences between the two groups in age,body mass index,cardiovascular risk factors,oral medication after discharge,laboratory test indicators and changes in ECG ST segment.During the 18-month follow-up period,there were 9all-cause deaths and 29 cases of MACCE in both groups.MACCE included 13 cases of cardiogenic death(44.83%),3 cases of non-fatal myocardial infarction(10.34%),1case of heart failure(3.45%),6 cases of cardiovascular re-hospitalization(20.69%),and 6 cases of stroke(20.69%).Kaplan-Meier cumulative survival curve showed that OSAHS was significantly associated with all-cause mortality(log-rank P=0.02)and MACCE(log-rank P=0.03)events.In univariate Cox regression analysis,OSAHS predicted all-cause mortality(HR=1.78;95% CI: 0.92~1.96;P=0.04)and MACCE event(HR=1.93;95% CI: 1.35~2.86;P<0.01).Multivariate Cox regression analysis after adjusting for age,sex,cardiovascular risk factors and medication showed that OSAHS was still associated with all-cause mortality(HR=1.71;95% CI: 1.28~2.43;P<0.01)and MACCE event(HR=1.75;95% CI: 1.20~2.45;P=0.03).Notably,statins,renin-angiotensin-aldosterone system(RAAS)inhibitors,and ST-segment elevation myocardial infarction(STEMI)were significantly associated with clinical outcome.Conclusions OSAHS is an independent risk factor for all-cause mortality and MACCE in patients with MINOCA.Active treatment of OSAHS should be considered to improve the prognosis of patients with MINOCA.