Differential likelihood of NSTEMI vs STEMI in patients with sleep apnea. (1st December 2017)

• Record Type: Journal Article
• Authors: Ludka, Ondrej; Stepanova, Radka; Sert-Kuniyoshi, Fatima; Spinar, Jindrich; Somers, Virend K.; Kara, Tomas
• Is Part Of: International journal of cardiology. Volume 248(2017)
• Page Start: 64
• Page End: 68
• Publication Date: 2017-12-01
• Subjects: ACE angiotensin converting enzyme -- AHI apnea-hypopnea index -- ASA aspirin -- BMI body mass index -- CS Cheyne-Stokes -- CSA central sleep apnea -- DBP diastolic blood pressure -- eGFR MDRD estimated glomerular filtration rate using modification of diet in renal disease formula -- HR heart rate -- LAD left anterior descending -- LVEF left ventricular ejection fraction -- MI myocardial infarction -- NSTEMI non-ST elevation myocardial infarction -- ODI oxygen desaturation index -- OSA obstructive sleep apnea -- PCI percutaneous coronary interventions -- RCA right coronary artery -- RCX circumflex branch of left coronary artery -- RIM ramus intermedius -- SA sleep apnea -- SBP systolic blood pressure -- STEMI ST elevation myocardial infarction -- TIA transient ischemic attack; Sleep apnea -- Non-ST-elevation myocardial infarction -- ST-elevation myocardial infarction -- Ischemic preconditioning; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2017.06.034
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Sleep apnea (SA) is associated with intermittent hypoxemia that may lead to ischemic preconditioning in the myocardium. This potential cardioprotective effect of SA may play a role in the development of non-ST-elevation myocardial infarction (NSTEMI) versus ST-elevation myocardial infarction (STEMI) during acute ischemia. However, there is limited evidence about the relative prevalence of NSTEMI versus STEMI in SA patients. We therefore prospectively investigated the prevalence of these two types of MI in patients with SA. Methods: We prospectively studied 782 consecutive patients admitted with the diagnosis of acute MI (both NSTEMI and STEMI). All subjects underwent sleep evaluations using a portable diagnostic device after at least 48 h post-admission, provided they were in stable condition. Six hundred and seven out of 782 patients had technically adequate sleep studies, and therefore were included in the final analysis. Results: SA was present in 65.7% (n = 399) and NSTEMI in 30% (n = 182) of patients. Increasing severity of SA was associated with increasing likelihood of NSTEMI, and with decreasing likelihood of STEMI (p < 0.001). Relative frequency of NSTEMI in the moderate to severe SA group (AHI ≥ 15 events/h) was 40.6% versus 29.9% for STEMI (p = 0.01). Conclusion: The prevalence of NSTEMI increases with increasing severity of SA. This finding may suggest a cardioprotective role of SA, which may attenuate the development of STEMI, perhaps through ischemic preconditioning.