残余SYNTAX评分对阻塞性睡眠呼吸暂停合并急性冠状动脉综合征患者预后的前瞻性队列研究  

A prospective cohort study to evaluate the prognostic impact of residual SYNTAX score in patients with obstructive sleep apnea and acute coronary syndrome

作　　者：曾亚平[1] 杨树涵[2] 王晓[1] 范靖瑶 张新勇[1] 聂绍平[1] ZENG Yaping;YANG Shuhan;WANG Xiao;FAN Jingyao;ZHANG Xinyong;NIE Shaoping(Center for Coronary Artery Disease,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所冠心病中心,100029 [2]河南省新乡市中心医院心血管内科

出　　处：《心肺血管病杂志》2021年第9期896-901,共6页Journal of Cardiovascular and Pulmonary Diseases

基　　金：国家自然科学青年基金(81800308);北京市医院管理局青苗计划(QML20170604);本科生科研创新项目基金(XSKY2021)。

摘　　要：目的:观察残余SYNTAX评分(rSS)对合并阻塞性睡眠呼吸暂停(OSA)的急性冠状动脉综合征(ACS)患者预后的影响。方法:对住院期间接受经皮冠状动脉造影并完成睡眠监测的ACS患者进行前瞻性研究。评估基线SYNTAX(bSS)和血运重建后rSS。本研究依据血运重建是否完全分为:完全血运重建(CR,rSS=0)和不完全血运重建(ICR,rSS>0)。根据呼吸暂停低通气指数(AHI)分为:OSA组(AHI≥15)和非OSA组(AHI<15)。研究的主要终点是主要不良心脑血管事件(MACCEs),定义为心血管死亡、心肌梗死、脑卒中、缺血驱动的血运重建,或因不稳定型心绞痛或心力衰竭住院。结果:共752例患者纳入该研究。平均随访1年,OSA组的MACCEs发生率明显高于非OSA组(HR=1.68,95%CI:1.04~2.72,P=0.034)。合并ICR的OSA患者发生MACCEs的风险比非OSA合并CR组高5.1倍(P=0.007)。结论:合并OSA和ICR的ACS患者1年内MACCEs发生率较高。对合并OSA的ACS患者进行完全血运重建,可以改善临床预后。Objective:The aims was to evaluate the prognostic impact of the residual SYNTAX Score(rSS)in patients with obstructive sleep apnea(OSA)and acute coronary syndrome.Methods:Patients admit-ted for ACS and undergoing coronary angiography were prospectively enrolled.The baseline syntax score(bSS)and the rSS after revascularization were assessed.Complete revascularization(CR,rSS=0)and incomplete re-vascularization(ICR,rSS>0)were categorized.Overnight sleep study was conducted during hospitalization.OSA(apnea hypopnea index,AHI≥15)and non-OSA(AHI<15)were grouped according to AHI.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 the non-OSA group(HR=1.68,95%CI:1.04-2.72,P=0.034).The OSA patients with ICR had a 5.1 higher risk of MACCEs compared with the non-OSA with CR group(P=0.007).Conclusions:ACS patients with OSA and ICR have a high rate of MACCEs at 1 year.Adequacy level of revascularization is recommended to optimize clinical outcomes in ACS patients with OSA.

关 键 词：阻塞性睡眠呼吸暂停 残余SYNTAX评分 急性冠状动脉综合征 

分 类 号：R54[医药卫生—心血管疾病]