Occurrence of Coronary Collaterals in Acute Myocardial Infarction and Sleep Apnea

Verena Summerer, Michael Arzt, Henrik Fox, Olaf Oldenburg, Florian Zeman, Kurt Debl, Stefan Buchner, Stefan Stadler, Verena Summerer, Michael Arzt, Henrik Fox, Olaf Oldenburg, Florian Zeman, Kurt Debl, Stefan Buchner, Stefan Stadler

Abstract

Background In patients with acute myocardial infarction (MI), cardioprotective effects of obstructive sleep apnea are postulated on account of hypoxemic preconditioning. The aim of this single-center substudy was to investigate a potential association between obstructive sleep apnea and the presence of coronary collaterals in patients with first-time acute MI who have been enrolled in an ongoing, multicenter clinical trial. Methods and Results In TEAM-ASV I (Treatment of Sleep Apnea Early After Myocardial Infarction With Adaptive Servo-Ventilation Trial; NCT02093377) patients with first acute MI who received a coronary angiogram within 24 hours after onset of symptoms underwent polygraphy within the first 3 days. Coronary collaterals were classified visually by assigning a Cohen-Rentrop Score (CRS) ranging between 0 (no collaterals) and 3. Of 94 analyzed patients, 14% had significant coronary collaterals with a CRS ≥2. Apnea-Hypopnea Index (AHI) score was significantly higher in patients with CRS ≥2 compared with those with CRS <2 (31/hour [11-54] versus 13/hour [4-27]; P=0.032). A multivariable regression model revealed a significant association between obstructive AHI and CRS ≥2 that was independent of age, sex, body mass index, and culprit lesion left anterior descending artery (odds ratio [OR], 1.06; 95% CI, 1.01-1.12; P=0.023), but no significant association between coronary collaterals and central AHI (OR, 1.02; 95% CI, 0.97-1.08; P=0.443). Conclusions Patients with first-time acute MI had more extensive coronary collateralization with an increased AHI or rather an increased obstructive AHI. This finding supports the hypothesis that obstructive sleep apnea exerts potential cardioprotective effects, in addition to its known deleterious effects, in patients with acute MI. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02093377.

Keywords: coronary collaterals; hypoxic preconditioning; myocardial infarction; sleep‐disordered breathing.

Conflict of interest statement

Arzt received research grants from ResMed, the ResMed Foundation, Philips Respironics, and the Else‐Kröner Fresenius Foundation (2018_A159), as well as lecture and consulting fees from ResMed, Philips Respironics, Boehringer‐Ingelheim, NRI, Novartis, and Bresotec. The remaining authors have no disclosures to report.

Figures

Figure 1. Coronary collaterals classified to the…
Figure 1. Coronary collaterals classified to the Cohen‐Rentrop Score.
Shown are cranial projections in which the left anterior descending artery collateralizes the occluded right coronary artery. Arrows mark the collaterals. A, grade 0=no filling of collateral vessels; B, grade 1=filling of collateral vessels without any opacification of the epicardial recipient artery; C, grade 2=partial filling of the target epicardial artery by collateral vessels; D, grade 3=complete epicardial filling of the recipient artery by collaterals.
Figure 2. Study flow chart.
Figure 2. Study flow chart.
CMR indicates cardiac magnetic resonance imaging; CRS, Cohen‐Rentrop Score; and TEAM‐ASV I, Treatment of Sleep Apnea Early After Myocardial Infarction With Adaptive Servo‐Ventilation Trial.

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