Sleep-Disordered Breathing Linked to Cardiocerebrovascular Events After PCI

The presence of sleep-disordered breathing (SDB) among patients with acute coronary syndrome (ACS) following primary percutaneous coronary intervention (PCI) is associated with a higher incidence of major adverse cardiocerebrovascular events during long-term follow-up, according to a new study.

“It is important to identify factors that might contribute to worsening of clinical outcomes in patients with ACS,” the researchers said. “Although a few studies have suggested that SDB is such a factor, the relationship between SDB and long-term clinical outcomes following ACS has not been fully evaluated. Through this study, we aimed to test our hypothesis that SDB is associated with poor long-term clinical outcome following ACS.”

Researchers performed overnight cardiorespiratory monitoring of 241 patients with ACS successfully treated with primary PCI between January 2005 and December 2008. They defined the presence of SDB as an apnea-hypopnea index ≥5 events per hour. The endpoint was incidence of major adverse cardiocerebrovascular events, defined as a composite of all-cause death, recurrence of ACS, nonfatal stroke, and hospital admission for congestive heart failure (CHF). The investigators followed patients’ cases for a median period of 5.6 years.

They found comorbidity of SDB with ACS in 126 patients (52.3%). The cumulative incidence of major adverse cardiocerebrovascular events was significantly higher in patients with SDB than in those without SDB (21.4% vs 7.8%). Multivariable analysis revealed the presence of SDB to be a significant predictor of major adverse cardiocerebrovascular events (hazard ratio, 2.28; 95% confidence interval, 1.06-4.92).

“The presence of SDB among ACS patients following primary PCI is associated with a higher incidence of major adverse cardiocerebrovascular events, especially the incidence of CHF events, during long-term follow-up periods,” the researchers concluded. “Randomized clinical trials investigating whether specific treatment for coexisting SDB in ACS patients following PCI would cause an improvement in clinical outcomes will provide further information regarding the importance of detecting SDB in patients following ACS and PCI.”

­–Mike Bederka

Reference:

Mazaki T, Kasai T, Yokoi H, et al. Impact of sleep-disordered breathing on long-term outcomes in patients with acute coronary syndrome who have undergone primary percutaneous coronary intervention [published online June 15, 2016]. J Am Heart Assoc. doi:10.1161/JAHA.116.003270.