Wang X, Hao W, Fan J Y, Guo R F, Huang X, Li Z X, Li S Y, Wang G, Zhang Y, Gong W, Nie S P
Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100176, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2021 Aug 24;49(8):776-782. doi: 10.3760/cma.j.cn112148-20210423-00368.
To investigate the impact of obstructive sleep apnea (OSA) on long-term cardiovascular outcomes in patients with acute coronary syndrome (ACS). This is a single-center, prospective cohort study. Between June 2015 to January 2020, consecutive ACS patients hospitalized at Beijing Anzhen Hospital, Capital Medical University were enrolled. All patients underwent portable sleep breathing monitoring, and they were then divided into moderate/severe OSA group (apnea-hypopnea index (AHI)≥15 events/hour) and no/mild OSA group (AHI<15 events/hour). The primary endpoint was major adverse cardiac and cerebrovascular event (MACCE), defined as a composite of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, ischemia-driven revascularization and hospital admission for unstable angina or heart failure. MACCE were compared yearly by the log-rank test. Multivariable Cox regression analyses were performed to determine the independent predictors of MACCE. A total of 1 927 patients with ACS were enrolled, including 1 629 males (84.5%), aged (56.4±10.5) years. Moderate/severe OSA was present in 1 014 (52.6%) patients. Compared with no/mild OSA group, moderate/severe OSA group exhibited a higher body mass index (<0.05). Hypertension, prior PCI were more prevalent in moderate/severe OSA group (both <0.05). The difference of ACS category between the two groups was statistically significant (=0.021). The rate of patients who underwent PCI and the number of stents were higher in the moderate/severe OSA group. During a 5-year follow-up (median 2.9 years (IQR 1.5-3.6 years)), the cumulative incidence of MACCE was significantly higher in the moderate/severe OSA group than in the no/mild OSA group (34.0% vs. 24.0%, =1.346, 95% 1.100-1.646, log-rank =0.004). The cumulative incidence of MACCE remained statistically higher at 4 and 5 year in the moderate/severe OSA group as compared to the no/mild OSA group (33.3% vs. 22.9%, =1.397, 95% 1.141-1.710, log-rank =0.001; 34.0% vs. 24.0%, =1.341, 95% 1.096-1.640 log-rank =0.004, respectively). Multivariate analysis showed that moderate/severe OSA (=1.312, 95% 1.054-1.631, =0.015) was an independent predictor of long-term MACCE in ACS patients. Moderate/severe OSA is observed in more than 52% ACS patients. Moderate/severe OSA is an independent predictor of long-term MACCE.
探讨阻塞性睡眠呼吸暂停（OSA）对急性冠状动脉综合征（ACS）患者长期心血管结局的影响。这是一项单中心前瞻性队列研究。2015年6月至2020年1月期间，首都医科大学附属北京安贞医院连续收治的ACS患者入组。所有患者均接受便携式睡眠呼吸监测，然后分为中重度OSA组（呼吸暂停低通气指数（AHI）≥15次/小时）和无/轻度OSA组（AHI＜15次/小时）。主要终点是主要不良心脑血管事件（MACCE），定义为心血管死亡、非致命性心肌梗死、非致命性卒中、缺血驱动的血运重建以及因不稳定型心绞痛或心力衰竭住院的综合情况。每年通过对数秩检验比较MACCE。进行多变量Cox回归分析以确定MACCE的独立预测因素。共纳入1927例ACS患者，其中男性1629例（84.5%），年龄（56.4±10.5）岁。1014例（52.6%）患者存在中重度OSA。与无/轻度OSA组相比，中重度OSA组的体重指数更高（P＜0.05）。高血压、既往PCI在中重度OSA组更为常见（均P＜0.05）。两组间ACS类别差异有统计学意义（P = 0.021）。中重度OSA组接受PCI的患者比例和支架置入数量更高。在5年随访期间（中位随访2.9年（四分位间距1.
