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OBSTRUCTIVE SLEEP APNEA AND DIABETES MELLITUS HAVE SYNERGISTIC EFFECTS ON ADVERSE CARDIAC AND CEREBROVASCULAR EVENTS IN PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION
127 JACC March 21, 2017 Volume 69, Issue 11
Acute and Stable Ischemic Heart Disease OBSTRUCTIVE SLEEP APNEA AND DIABETES MELLITUS HAVE SYNERGISTIC EFFECTS ON ADVERSE CARDIAC AND CEREBROVASCULAR EVENTS IN PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION Poster Contributions Poster Hall, Hall C Friday, March 17, 2017, 3:45 p.m.-4:30 p.m. Session Title: Coronary Angiography, Intra-Vascular Imaging, Revascularization and Outcomes Abstract Category: 2. Acute and Stable Ischemic Heart Disease: Clinical Presentation Number: 1166-335 Authors: Chieh Yang Koo, Luciano Drager, Hee-Hwa Ho, Thet Hein, Man-Hong Jim, Mark Chan, Mark Richards, Huay-Cheem Tan, BeeChoo Tai, Junjie Zhang, Rishi Sethi, Chi-Hang Lee, Sleep and Stent Study Investigators, National University Heart Center, Singapore, Singapore
Background: Obstructive sleep apnea (OSA) predicted major adverse cardiac and cerebrovascular events (MACCE) in patients undergoing percutaneous coronary intervention (PCI) in the multi-center Sleep and Stent Study. In this post-hoc analysis, we determined the relative and combined prognostic impacts of OSA and diabetes mellitus (DM).
Methods: 1311 patients were reclassified into 4 groups based on OSA and DM status. The primary end point was MACCE - a composite of cardiovascular (CV) mortality, non-fatal myocardial infarction, non-fatal stroke and unplanned revascularization. The median follow-up was 1.9 years.
Results: There were 433 OSA(─)DM(─), 323 OSA(+)DM(─), 284 OSA(─)DM(+) and 271 OSA(+)DM(+) patients. The crude cumulative incidence of MACCE (Fig.) was highest in OSA(+)DM(+) (3-year estimate, 22.3%), similar in OSA(+)DM(─) (15.2%) and OSA(─)DM(+) (17.1%), and lowest in OSA(─)DM(─) (11.8%; p<0.001) groups. Likewise, the crude incidence of CV mortality was highest in OSA(+) DM(+) (3-year estimate, 7.4%), but similar in OSA(+)DM(─) (2.7%), OSA(─)DM(+) (1.4%) and OSA(─)DM(─) (1.1%; p=0.002) groups. By Cox regression analysis, OSA(+)DM(+) independently predicted MACCE (adjusted hazard ratio, 2.29; 95% confidence interval, 1.38─3.81; P=0.015) and CV mortality (adjusted subdistribution hazard ratio, 5.59; 95% confidence interval, 1.45─21.56; P=0.018) as compared to OSA(─)DM(─).
Conclusions: OSA and DM exerted a synergistic negative prognostic impact on patients undergoing PCI.
Acute and Stable Ischemic Heart Disease OBSTRUCTIVE SLEEP APNEA AND DIABETES MELLITUS HAVE SYNERGISTIC EFFECTS ON ADVERSE CARDIAC AND CEREBROVASCULAR EVENTS IN PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION Poster Contributions Poster Hall, Hall C Friday, March 17, 2017, 3:45 p.m.-4:30 p.m. Session Title: Coronary Angiography, Intra-Vascular Imaging, Revascularization and Outcomes Abstract Category: 2. Acute and Stable Ischemic Heart Disease: Clinical Presentation Number: 1166-335 Authors: Chieh Yang Koo, Luciano Drager, Hee-Hwa Ho, Thet Hein, Man-Hong Jim, Mark Chan, Mark Richards, Huay-Cheem Tan, BeeChoo Tai, Junjie Zhang, Rishi Sethi, Chi-Hang Lee, Sleep and Stent Study Investigators, National University Heart Center, Singapore, Singapore
Background: Obstructive sleep apnea (OSA) predicted major adverse cardiac and cerebrovascular events (MACCE) in patients undergoing percutaneous coronary intervention (PCI) in the multi-center Sleep and Stent Study. In this post-hoc analysis, we determined the relative and combined prognostic impacts of OSA and diabetes mellitus (DM).
Methods: 1311 patients were reclassified into 4 groups based on OSA and DM status. The primary end point was MACCE - a composite of cardiovascular (CV) mortality, non-fatal myocardial infarction, non-fatal stroke and unplanned revascularization. The median follow-up was 1.9 years.
Results: There were 433 OSA(─)DM(─), 323 OSA(+)DM(─), 284 OSA(─)DM(+) and 271 OSA(+)DM(+) patients. The crude cumulative incidence of MACCE (Fig.) was highest in OSA(+)DM(+) (3-year estimate, 22.3%), similar in OSA(+)DM(─) (15.2%) and OSA(─)DM(+) (17.1%), and lowest in OSA(─)DM(─) (11.8%; p<0.001) groups. Likewise, the crude incidence of CV mortality was highest in OSA(+) DM(+) (3-year estimate, 7.4%), but similar in OSA(+)DM(─) (2.7%), OSA(─)DM(+) (1.4%) and OSA(─)DM(─) (1.1%; p=0.002) groups. By Cox regression analysis, OSA(+)DM(+) independently predicted MACCE (adjusted hazard ratio, 2.29; 95% confidence interval, 1.38─3.81; P=0.015) and CV mortality (adjusted subdistribution hazard ratio, 5.59; 95% confidence interval, 1.45─21.56; P=0.018) as compared to OSA(─)DM(─).
Conclusions: OSA and DM exerted a synergistic negative prognostic impact on patients undergoing PCI.