Obstructive sleep apnea (OSA) is common among patients with coronary artery disease (CAD) and is independently associated with adverse outcomes following percutaneous coronary intervention (PCI), even after adjustment for traditional risk factors. ,, OSA is increasingly recognized as a systemic proinflammatory condition driven by intermittent hypoxia, sympathetic activation, oxidative stress, and endothelial dysfunction. These processes are associated with elevations in circulating inflammatory biomarkers, including high-sensitivity C-reactive protein (hsCRP), which has been independently linked to poor cardiovascular outcomes. ,,,, Inflammation has therefore been hypothesized as a potential mechanism linking OSA to adverse outcomes following PCI. Nonetheless, the impact of inflammation on OSA patients undergoing PCI remains poorly defined. We sought to examine the association between hsCRP, measured at the time of PCI, and one-year outcomes among patients with OSA.
We included all patients with OSA who underwent PCI at a high-volume tertiary-care center from 2012 to 2023. Patients with active cancer, cardiogenic shock, hsCRP>10 mg/L, STEMI presentation, or missing hsCRP values were excluded. Patients with hsCRP>10 mg/L were excluded in order to reduce confounding, as such severely elevated values are more likely to reflect active infectious processes or severe acute phase responses. Patients were stratified by hsCRP levels, measured at index PCI, using a cutoff of 2 mg/L. The primary endpoint was one-year major adverse cardiovascular events (MACE), a composite of all-cause death, myocardial infarction, stroke, and target-vessel revascularization. Hazard ratios (HR) and 95% confidence intervals (CI) were generated using Cox proportional hazards models. Adjustments were made a priori for age, sex, current smoking, diabetes, anemia, lung disease, chronic kidney disease (CKD), and moderate/severe calcification.
Among 1,571 patients with OSA, 832 had hsCRP≥2mg/L (mean hsCRP 4.6 ± 2.1mg/L), and 739 had hsCRP< 2 mg/L (mean hsCRP 1.0 ± 0.5 mg/L). Patients with hsCRP≥2 mg/L, compared to hsCRP< 2 mg/L, were older, more often female, with a higher BMI, and with a significantly higher prevalence of comorbidities, including smoking, diabetes, anemia, lung disease, and CKD ( Table 1 ).
Table 1
Baseline characteristics and one-year outcomes
| Baseline characteristics | ||||||
|---|---|---|---|---|---|---|
| Overall n=1571 | hsCRP≥2 mg/L n=832 (53.0%) | hsCRP<2 mg/L n=739 (47.0%) | p-value | |||
| Age, years | 64.6 ± 10.5 | 64.1 ± 10.7 | 65.2 ± 10.3 | 0.044 | ||
| BMI, kg/m 2 | 32.7 ± 6.3 | 34.2 ± 6.5 | 31.0 ± 5.6 | <0.001 | ||
| Female sex | 309 (19.7%) | 192 (23.1%) | 117 (15.8%) | <0.001 | ||
| Smoking | 161 (10.3%) | 110 (13.2%) | 51 (6.9%) | <0.001 | ||
| Anemia | 521 (34.0%) | 317 (39.0%) | 204 (28.4%) | <0.001 | ||
| Diabetes | 787 (50.1%) | 462 (55.5%) | 325 (44.0%) | <0.001 | ||
| Lung disease | 213 (13.6%) | 141 (16.9%) | 72 (9.8%) | <0.001 | ||
| Atrial fibrillation | 200 (12.7%) | 123 (14.8%) | 77 (10.4%) | 0.010 | ||
| CKD | 409 (26.0%) | 256 (30.8%) | 153 (20.7%) | <0.001 | ||
| Lung disease | 213 (13.6%) | 141 (16.9%) | 72 (9.8%) | <0.001 | ||
| Multi-vessel disease | 942 (60.0%) | 501 (60.2%) | 441 (59.7%) | 0.827 | ||
| Moderate/severe calcification | 443 (28.2%) | 212 (25.5%) | 231 (31.3%) | 0.011 | ||
| Unadjusted and adjusted outcomes | ||||||
|---|---|---|---|---|---|---|
| hsCRP≥2mg/L | hsCRP<2mg/L | HR (95% CI) | p-value | aHR (95% CI) | p-value | |
| MACE | 100 (13.1%) | 59 (8.8%) | 1.51 (1.09-2.08) | 0.012 | 1.36 (0.98-1.89) | 0.070 |
| All-cause death | 16 (2.2%) | 7 (1.0%) | 2.01 (0.83-4.88) | 0.124 | 1.64 (0.66-4.08) | 0.285 |
| MI | 22 (2.8%) | 14 (2.0%) | 1.39 (0.71-2.71) | 0.341 | 1.2 (0.60-2.38) | 0.612 |
| Stroke | 3 (0.4%) | 1 (0.1%) | 2.65 (0.28-25.5) | 0.399 | 2.97 (0.30-29.5) | 0.352 |
| TVR | 72 (9.6%) | 46 (6.9%) | 1.39 (0.96-2.01) | 0.081 | 1.27 (0.87-1.86) | 0.218 |
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