Fan Kangjun, Gao Mingxin, Yu Wenyuan, Liu Hongli, Chen Liang, Ding Xiaohang, Yu Yang
Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Front Cardiovasc Med. 2021 Jul 8;8:689795. doi: 10.3389/fcvm.2021.689795. eCollection 2021.
The impact of obstructive sleep apnea (OSA) on perioperative myocardial infarction (PMI) following coronary artery bypass grafting (CABG) remains unclear. Off-pump CABG (OPCABG) has become a common practice for CABG in China. The present study investigated mainly the correlation between OSA and PMI following OPCABG. In this prospective observational single-center study, consecutive eligible patients listed for elective OPCABG underwent cardiorespiratory polygraphy before surgery between January 2019 and June 2020. OSA was defined as an apnea-hypopnea index (AHI) ≥15 events/h. The primary end point was perioperative myocardial infarction (PMI) following OPCABG (type 5 MI). Patients with OSA accounted for 42.2% (62/147) of the cohort. Twenty-four patients (16.3%) met the protocol criteria for PMI: 17 (27.4%) in the OSA group and 7 (8.2%) in the non-OSA group ( = 0.002). Multivariate logistic regression analysis revealed that AHI (OR = 1.115, 95% CI 1.066 to 1.166, < 0.001), high-sensitivity c-reactive protein (hs-CRP) (OR = 1.080, 95% CI 1.025 to 1.138, = 0.004), and SYNTAX score (OR = 1.098, 95% CI 1.056 to 1.141, < 0.001) were associated with PMI incidence. Furthermore, ROC analysis revealed that the AHI (AUC = 0.766, 95% CI 0.689 to 0.832, < 0.001) and SYNTAX score (AUC = 0.789, 95% CI 0.715 to 0.852, < 0.001) had predictive value for PMI. In addition, multiple linear regression analysis showed that the AHI was an independent influencing factor of hs-CRP (B = 0.176, 95% CI 0.090 to 0.263, < 0.001) and the SYNTAX score (B = 0.553, 95% CI 0.397 to 0.709, < 0.001). OSA was independently associated with a higher incidence of PMI following OPCABG, and the formation of severe coronary atherosclerotic lesions aggravated by an enhanced inflammatory response might be the potential mechanism. The efficacy of CPAP treatment for improving prognosis after CABG remains to be further investigated.
阻塞性睡眠呼吸暂停（OSA）对冠状动脉旁路移植术（CABG）后围手术期心肌梗死（PMI）的影响尚不清楚。非体外循环冠状动脉旁路移植术（OPCABG）在中国已成为CABG的常见术式。本研究主要探讨了OPCABG术后OSA与PMI之间的相关性。在这项前瞻性观察性单中心研究中，2019年1月至2020年6月期间，连续入选的择期OPCABG合格患者在手术前接受了心肺多导睡眠监测。OSA定义为呼吸暂停低通气指数（AHI）≥15次/小时。主要终点是OPCABG术后的围手术期心肌梗死（PMI，5型心肌梗死）。OSA患者占队列的42.2%（62/147）。24例患者（16.3%）符合PMI的方案标准：OSA组17例（27.4%），非OSA组7例（8.2%）（P = 0.002）。多因素逻辑回归分析显示，AHI（OR = 1.115，95%CI 1.066至1.166，P < 0.001）、高敏C反应蛋白（hs-CRP）（OR = 1.080，95%CI 1.025至1.138，P = 0.004）和SYNTAX评分（OR = 1.098，95%CI 1.056至1.141，P < 0.001）与PMI发生率相关。此外，ROC分析显示，AHI（AUC = 0.766，95%CI 0.689至0.832，P < 0.001）和SYNTAX评分（AUC = 0.789，95%CI 0.715至0.852，P < 0.001）对PMI具有预测价值。此外，多元线性回归分析显示，AHI是hs-CRP（B = 0.176，95%CI 0.090至0.263，P < 0.001）和SYNTAX评分（B = 0.553，95%CI 0.397至0.709，P < 0.001）的独立影响因素。OPCABG术后，OSA与较高的PMI发生率独立相关，炎症反应增强加重的严重冠状动脉粥样硬化病变的形成可能是潜在机制。CPAP治疗改善CABG后预后的疗效仍有待进一步研究。
