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Impact of severe OSA on pharmacoinvasive treatment in ST elevation myocardial infarction patients

  • Fabrizio Maroja
  • Adriano Caixeta
  • Dalva Poyares
  • Sergio Tufik
  • Angelo de Paola
  • Laura Castro
  • Luciana Storti
  • Patrick Burke
  • Fatima CintraEmail author
Sleep Breathing Physiology and Disorders • Original Article
  • 4 Downloads

Abstract

Purpose

The negative association between obstructive sleep apnea (OSA) and adverse cardiovascular outcomes in patients undergoing percutaneous coronary intervention (PCI) is well documented. However, little is known about the influence of OSA on fibrinolytic therapy. The aim of this study was to evaluate the impact of severe OSA on pharmacoinvasive treatment in ST elevation myocardial infarction (STEMI) patients.

Methods

We enrolled consecutive STEMI patients without previous vascular disease, heart failure, or OSA diagnosis. All patients underwent either a pharmacoinvasive therapy or primary PCI. Syntax score (SS) was calculated for all patients, and a full bedside polysomnography was performed in the first 72 h of admission. In-hospital events and 30 days readmissions were analyzed.

Results

The sample included 116 patients, 87 men. Patients with severe OSA were older (p = 0.01), had higher neck and abdominal circumferences (p < 0.01), and had higher BMI (p < 0.01). They also had lower reperfusion rates post-fibrinolysis (20 vs. 65%; p = 0.001), higher SS (20.2 ± 11.2 vs. 14.6 ± 10.6; p = 0.03), lower left ventricle ejection fraction (45 ± 8 vs. 51 ± 10%; p = 0.02), and a higher incidence of atrial arrhythmias (4 vs. 21%; p = 0.02). STEMI patients with severe OSA presented with threefold increase in the risk for at least one adverse outcome. Regression analysis showed that both severe OSA and hypertension were independent predictors of higher SS.

Conclusion

Severe OSA was associated with a poor outcome after pharmacoinvasive treatment in STEMI patients.

Keywords

Obstructive sleep apnea Fibrinolysis Acute coronary syndrome 

Notes

Acknowledgments

This study was supported by the Associação Fundo de Incentivo à Pesquisa (AFIP), which provided personnel and the polysomnographic systems used during data collection.

Funding information

This study was funded by the Associação Fundo de Pesquisa em psicofarmacologia (AFIP/2016).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Medicine DepartmentUniversidade Federal de São PauloSão PauloBrazil
  2. 2.Hospital Israelita Albert EinsteinSão PauloBrazil

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