Nakashima Hiroshi, Kurobe Masaya, Minami Kazutoshi, Furudono Shinnosuke, Uchida Yuzou, Amenomori Kentarou, Nunohiro Tatsuya, Takeshita Satoshi, Maemura Koji
Department of Cardiology, Nagasaki Citizens Hospital, Japan
Department of Cardiology, Nagasaki Citizens Hospital, Japan.
Eur Heart J Acute Cardiovasc Care. 2015 Feb;4(1):75-84. doi: 10.1177/2048872614530865. Epub 2014 May 22.
It is unclear whether obstructive sleep apnea (OSA) increases the recurrence of acute coronary syndrome (ACS) in patients with acute myocardial infarction (MI). We hypothesized that moderate-to-severe OSA increased the number of adverse cardiovascular events in patients who underwent primary percutaneous coronary intervention (PCI).
This study included 272 patients with acute MI. Polysomnography at first admission determined that 124 patients suffered from moderate-to-severe OSA. The main study outcome measures were cardiac death, recurrence of ACS, and re-admission for heart failure. Major adverse cardiac events (MACEs) were defined as composite end points of individual clinical outcomes. Follow-up coronary angiograms were obtained in 222 patients. PCI-related measures were target vessel revascularization and newly necessitated PCI for progressive lesions. The moderate-to-severe OSA patients had increased ACS recurrence and MACEs compared with patients with mild OSA or without sleep apnea (16% vs. 7%, p = 0.014; 22% vs. 11%, p = 0.014, respectively). PCI for progressive lesions was also higher in the moderate-to-severe OSA patients (28% vs. 15%, p = 0.015). Cox regression analysis showed that moderate-to-severe OSA was an independent predictor of ACS recurrence (hazard ratio = 2.30, p = 0.040). In addition, moderate-to-severe OSA was an independent predictor of PCI for progressive lesions, with a hazard ratio of 2.38 (p = 0.015).
Moderate-to-severe OSA increased the risk of ACS and the incidence of PCI for progressive lesions. Increased plaque vulnerability might be related to these clinical manifestations.
目前尚不清楚阻塞性睡眠呼吸暂停（OSA）是否会增加急性心肌梗死（MI）患者急性冠状动脉综合征（ACS）的复发率。我们推测，中重度OSA会增加接受直接经皮冠状动脉介入治疗（PCI）患者的不良心血管事件数量。
本研究纳入了272例急性MI患者。首次入院时进行的多导睡眠图检查确定，124例患者患有中重度OSA。主要研究结局指标为心源性死亡、ACS复发以及因心力衰竭再次入院。主要不良心脏事件（MACE）被定义为各个临床结局的复合终点。对222例患者进行了随访冠状动脉造影。PCI相关指标为靶血管血运重建以及因病变进展新需要进行的PCI。与轻度OSA或无睡眠呼吸暂停的患者相比，中重度OSA患者的ACS复发率和MACE增加（分别为16%对7%，p = 0.014；22%对11%，p = 0.014）。中重度OSA患者因病变进展进行的PCI也更高（28%对15%，p = 0.015）。Cox回归分析表明，中重度OSA是ACS复发的独立预测因素（风险比 = 2.30，p = 0.040）。此外，中重度OSA是因病变进展进行PCI的独立预测因素，风险比为2.38（p = 0.015）。
中重度OSA增加了ACS风险以及因病变进展进行PCI的发生率。斑块易损性增加可能与这些临床表现有关。
