Prognostic impact of residual SYNTAX score in patients with obstructive sleep apnea and acute coronary syndrome: a prospective cohort study

Yaping Zeng, Shuhan Yang, Xiao Wang, Jingyao Fan, Shaoping Nie, Yongxiang Wei, Yaping Zeng, Shuhan Yang, Xiao Wang, Jingyao Fan, Shaoping Nie, Yongxiang Wei

Abstract

Background: There is a paucity of data from large prospective study evaluating the prognostic significance of the residual Synergy between percutaneous intervention with Taxus drug-eluting stents and cardiac surgery (SYNTAX) Score (rSS) in patients with obstructive sleep apnea (OSA) and Acute Coronary Syndrome (ACS).

Methods: ACS patients who undergoing percutaneous coronary angiography and completing a sleep study during hospitalization were prospectively enrolled. The baseline SYNTAX Score (bSS) and the rSS after revascularization were assessed. Complete revascularization (CR, rSS = 0) and incomplete revascularization (ICR, rSS > 0) were categorized. OSA (apnea hypopnea index, AHI ≥ 15) and non-OSA (AHI < 15) were grouped according to AHI. The primary endpoint of the study was major adverse cardiovascular and cerebrovascular events (MACCEs), defined as a composite of cardiovascular death, myocardial infarction, stroke, ischemia-driven revascularization, or hospitalization for UAP or heart failure.

Results: Overall, 752 patients were prospectively enrolled. At a median follow-up of 1 year, the incidence of MACCEs was significantly higher in the OSA than in the non-OSA group (hazard ratio [HR]:1.68; 95% confidence interval [CI]:1.04-2.72; P = .034). ICR was associated with a higher risk of MACCEs in the non-OSA group (HR:3.34;95% CI:1.0-11.12; P = .05). The OSA patients with ICR had a 5.1 higher risk of MACCEs compared with the non-OSA with CR group, P = .007. The OSA patients with CR had a similar 1-year MACCEs as all the non-OSA patients (HR:1.10; 95% CI:0.515-2.349; P = 0.806).

Conclusions: ACS patients with OSA and ICR have a high rate of MACCEs at 1 year. In contrast, the prognosis of ACS patients with OSA but CR is favorable and similar to patients without OSA. Adequate level of revascularization is recommended to optimize clinical outcomes in ACS patients with OSA.

Trial registration: Clinicaltrials.gov identifier NCT03362385.

Keywords: Acute coronary syndrome; Obstructive sleep apnea; Residual SYNTAX score.

Conflict of interest statement

Ethics approval and consent to participate

The study was approved by the Institutional Review Board of Beijing Anzhen Hospital, Capital Medical University (2013025) and all patients provided written informed consent. All the authors consent to the publication of the manuscript.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Study flow chart
Fig. 2
Fig. 2
a: Correlation between the baseline and the residual SYNTAX Score. Relationship between the baseline (x-axis) and residual (y-axis) SYNTAX Score after angiography in 752 patients. A strong positive correlation was present between the baseline and the residual SYNTAX Score. b: Column bars of the baseline and residual SYNTAX Score in the OSA and non-OSA groups. SS = SYNTAX Score; OSA s = Obstructive Sleep Apnea; non-OSA = non-Obstructive Sleep Apnea
Fig. 3
Fig. 3
Kaplan-Meier curve showing cumulative events at follow-up in subgroup analysis: (a) MACCEs in the OSA patients and ICR, non-OSA and ICR, OSA and CR, non-OSA patients and CR. b Unstable angina pectoris in the OSA patients and ICR, non-OSA and ICR, OSA and CR, non-OSA and CR. MACCEs = major adverse cardiovascular and cerebrovascular events; UAP = unstable angina pectoris; OSA = Obstructive Sleep Apnea; non-OSA = non-Obstructive Sleep Apnea; CR = complete revascularization; ICR = incomplete revascularization

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