Key result
OSA is not significantly associated with post-ACS MACCE, despite higher risk after 1 year.
Why the study?
The prognostic significance of obstructive sleep apnea in patients with acute coronary syndrome in the contemporary era is unclear.
Does obstructive sleep apnea increase the risk of major adverse cardiovascular and cerebrovascular events in patients with acute coronary syndrome?
Cohort (n=804)
Does obstructive sleep apnea increase the risk of major adverse cardiovascular and cerebrovascular events in patients with acute coronary syndrome?
Hazard Ratio: 1.55 (95% CI 0.94–2.57)
p-value: p=0.085
In patients with acute coronary syndrome, obstructive sleep apnea is associated with a significantly increased risk of major adverse cardiovascular events occurring more than one year after the index event.
OSA lacks independent link to 1-year MACCE after ACS; leaves open late risk and need for treatment trials.
Background The prognostic significance of obstructive sleep apnea ( OSA ) in patients with acute coronary syndrome ( ACS ) in the contemporary era is unclear. We performed a large, prospective cohort study and did a landmark analysis to delineate the association of OSA with subsequent cardiovascular events after ACS onset. Methods and Results Between June 2015 and May 2017, consecutive eligible patients admitted for ACS underwent cardiorespiratory polygraphy during hospitalization. OSA was defined as an apnea‐hypopnea index ≥15 events·h −1 . The primary end point 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. OSA was present in 403 of 804 (50.1%) patients. During median follow‐up of 1 year, cumulative incidence of MACCE was significantly higher in the OSA group than in the non‐ OSA group (log‐rank, P =0.041). Multivariate analysis showed that OSA was nominally associated with incidence of MACCE (adjusted hazard ratio, 1.55; 95% CI, 0.94–2.57; P =0.085). In the landmark analysis, patients with OSA had 3.9 times the risk of incurring a MACCE after 1 year (adjusted hazard ratio, 3.87; 95% CI, 1.20–12.46; P =0.023), but no increased risk was found within 1‐year follow‐up (adjusted hazard ratio, 1.18; 95% CI, 0.67–2.09; P =0.575). No significant differences were found in the incidence of cardiovascular death, myocardial infarction, and ischemia‐driven revascularization, except for a higher rate of hospitalization for unstable angina in the OSA group than in the non‐ OSA group (adjusted hazard ratio, 2.10; 95% CI, 1.09–4.05; P =0.027). Conclusions There was no independent correlation between OSA and 1‐year MACCE after ACS . The increased risk associated with OSA was only observed after 1‐year follow‐up. Efficacy of OSA treatment as secondary prevention after ACS requires further investigation.
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Fan et al. (2019) conducted a cohort in Acute Coronary Syndrome (n=804). Obstructive Sleep Apnea vs. Non-OSA was evaluated on Major adverse cardiovascular and cerebrovascular event (MACCE), including cardiovascular death, myocardial infarction, stroke, ischemia-driven revascularization, or hospitalization for unstable angina or heart failure (adjusted HR 1.55, 95% CI 0.94-2.57, p=0.085). Obstructive sleep apnea was not significantly associated with overall MACCE after acute coronary syndrome (adjusted HR 1.55; 95% CI 0.94-2.57; P=0.085), though risk increased after 1 year.
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