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Chest. 2015 May;147(5):1352-1360. doi: 10.1378/chest.14-2152.

Impact of OSA on cardiovascular events after coronary artery bypass surgery.

Author information

1
Sleep Laboratory, Pulmonary Division, University of São Paulo Medical School, São Paulo; Hypertension Unit, University of São Paulo Medical School, São Paulo.
2
Sleep Laboratory, Pulmonary Division, University of São Paulo Medical School, São Paulo.
3
Physicobiology Department, Federal University, São Paulo.
4
Sleep and Heart Laboratory, Pronto Socorro Cardiológico de Pernambuco (PROCAPE) da Universidade de Pernambuco, Pernambuco, Brazil.
5
Clinical Unit of Chronic Coronary Heart Disease, Heart Institute (InCor), University of São Paulo Medical School, São Paulo.
6
Hypertension Unit, University of São Paulo Medical School, São Paulo; Hypertension Unit, Renal Division, University of São Paulo Medical School, São Paulo. Electronic address: luciano.drager@incor.usp.br.

Abstract

BACKGROUND:

The impact of OSA on new cardiovascular events in patients undergoing coronary artery bypass graft (CABG) surgery is poorly explored.

METHODS:

Consecutive patients referred for CABG underwent clinical evaluation and standard polysomnography in the preoperative period. CABG surgery data, including percentage of off-pump and on-pump CABG, number of grafts, and intraoperative complications, were collected. The primary end point was major adverse cardiac or cerebrovascular events (MACCEs) (combined events of all-cause death, myocardial infarction, repeated revascularization, and cerebrovascular events). Secondary end points included individual MACCEs, typical angina, and arrhythmias. Patients were evaluated at 30 days (short-term) and up to 6.1 years (long term) after CABG.

RESULTS:

We studied 67 patients (50 men; mean age, 58 ± 8 years; mean BMI, 28.5 ± 4.1 kg/m2). OSA (apnea-hypopnea index ≥ 15 events/h) was present in 56% of the population. The patients were followed for a mean of 4.5 years (range, 3.2-6.1 years). No differences were observed in the short-term follow-up. In contrast, MACCE (35% vs 16%, P = .02), new revascularization (19% vs 0%, P = .01), episodes of typical angina (30% vs 7%, P = .02), and atrial fibrillation (22% vs 0%, P = .0068) were more common in patients with than without OSA in the long-term follow-up. OSA was an independent factor associated with the occurrence of MACCE, repeated revascularization, typical angina, and atrial fibrillation in the multivariate analysis.

CONCLUSIONS:

OSA is independently associated with a higher rate of long-term cardiovascular events after CABG and may have prognostic and economic significance in CABG surgery.

PMID:
25612013
DOI:
10.1378/chest.14-2152
[Indexed for MEDLINE]

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