Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; National Clinical Research Center for Cardiovascular Diseases, Beijing, China.
Division of Cardiology, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, China.
Sleep Med. 2023 Dec;112:141-148. doi: 10.1016/j.sleep.2023.10.009. Epub 2023 Oct 12.
The prognostic significance of obstructive sleep apnea (OSA) in patients with acute coronary syndrome (ACS) according to prior myocardial infarction (MI) remains unclear. We aimed to investigate the association between OSA and long-term cardiovascular outcomes in ACS patients with or without prior MI.
We prospectively recruited eligible 2160 ACS patients with portable sleep monitoring in Beijing Anzhen Hospital between June 2015 and January 2020. OSA was defined as an apnea hypopnea index (AHI) ≥15 events/hour. The primary endpoint was major adverse cardiovascular and cerebrovascular event (MACCE), including cardiovascular death, myocardial infarction, stroke, ischemia-driven revascularization, or hospitalization for unstable angina or heart failure.
Among 1927 patients enrolled, 1014 (52.6%) had OSA and 316 (16.4%) had prior MI. During 2.9 (1.5, 3.6) years of follow-up, multivariate analysis showed that OSA was associated with 1.7 times the risk of MACCE in patients with prior MI (50 events [28.2%] vs 24 events [17.3%]; adjusted HR = 1.74, 95%CI 1.04-2.90, P = 0.034), but not in patients without prior MI group (177 events [21.1%] vs 138 events [17.8%]; adjusted HR = 1.19, 95%CI 0.94-1.51, P = 0.15). There was no significant interaction between prior MI and OSA for MACCE (interaction P = 0.14).
OSA was independently associated with an increased risk of MACCE among ACS patients, particularly among ACS patients with prior MI. Further trials exploring the efficacy of OSA treatment in high-risk patients with ACS characterized by prior MI are warranted.
阻塞性睡眠呼吸暂停（OSA）在急性冠状动脉综合征（ACS）患者中的预后意义，根据既往心肌梗死（MI）的情况尚不清楚。我们旨在研究 OSA 与 ACS 患者是否有或没有既往 MI 之间的长期心血管结局之间的关系。
我们前瞻性地在北京安贞医院招募了 2015 年 6 月至 2020 年 1 月期间接受便携式睡眠监测的 2160 名 ACS 患者。OSA 定义为每小时呼吸暂停低通气指数（AHI）≥15 次。主要终点是主要不良心血管和脑血管事件（MACCE），包括心血管死亡、心肌梗死、卒中和缺血驱动的血运重建或不稳定型心绞痛或心力衰竭住院。
在纳入的 1927 名患者中，有 1014 名（52.6%）患有 OSA，316 名（16.4%）有既往 MI。在 2.9（1.5，3.6）年的随访中，多变量分析表明，对于有既往 MI 的患者，OSA 与 MACCE 的风险增加 1.7 倍相关（50 例事件[28.2%]与 24 例事件[17.3%]；调整后的 HR=1.74，95%CI 1.04-2.90，P=0.034），但在没有既往 MI 的患者组中则不然（177 例事件[21.1%]与 138 例事件[17.8%]；调整后的 HR=1.19，95%CI 0.94-1.51，P=0.15）。在 MACCE 方面，既往 MI 和 OSA 之间没有显著的相互作用（相互作用 P=0.14）。
OSA 与 ACS 患者的 MACCE 风险增加独立相关，尤其是在有既往 MI 的 ACS 患者中。需要进一步的试验来探索 OSA 治疗在以既往 MI 为特征的高危 ACS 患者中的疗效。
