Obstructive Sleep Apnea and Cardiovascular Events After Percutaneous Coronary Intervention
Background—There is a paucity of data from large cohort studies examining the prognostic significance of obstructive sleep apnea (OSA) in patients with coronary artery disease. We hypothesized that OSA predicts subsequent major adverse cardiac and cerebrovascular events (MACCEs) in patients undergoing percutaneous coronary intervention (PCI).
Methods and Results—The Sleep and Stent Study was a prospective, multicenter registry of patients successfully treated with PCI in five countries. Between December 2011 and April 2014, 1748 eligible patients were prospectively enrolled. The 1311 patients who completed a sleep study within seven days of PCI formed the cohort for this analysis. Drug-eluting stents were used in 80.1% and bioresorbable vascular scaffolds in 6.3% of the patients, and OSA, defined as an apnea-hypopnea index ≥ 15 events per hour, was found in 45.3%. MACCE, a composite of cardiovascular mortality, non-fatal myocardial infarction, non-fatal stroke, and unplanned revascularization, occurred in 141 patients during the median follow-up of 1.9 years (interquartile range = 0.8 years). The crude incidence of an MACCE was higher in the OSA than non-OSA group (3-year estimate: 18.9% versus 14.0%; P = 0.001). Multivariate Cox regression analysis indicated OSA was a predictor of MACCE, with an adjusted hazard ratio of 1.57 (95% confidence interval = 1.10 to 2.24, P = 0.013), independent of age, sex, ethnicity, body mass index, diabetes mellitus, and hypertension.
Conclusions—OSA is independently associated with subsequent MACCE in patients undergoing PCI. Evaluation of therapeutic approaches to mitigate OSA-associated risk is warranted.
Clinical Trial Registration Information—ClinicalTrials.gov. Identifier: NCT01306526.
- Received September 9, 2015.
- Revision received March 1, 2016.
- Accepted March 18, 2016.