Article Text

PDF
Cardiovascular highlights from non-cardiology journals
  1. James M McCabe, JournalScan Editor
  1. University of Washington, Seattle, Washington, USA
  1. Correspondence to James M McCabe, University of Washington, 1959 NE Pacific St, Box 356422, Seattle, Washington, 98195 USA; jmmccabe{at}cardiology.washington.edu

Statistics from Altmetric.com

Continuous positive airway pressure fails to improve cardiovascular outcomes in obstructive sleep apnea

Obstructive sleep apnea (OSA) is associated with increased cardiovascular events in observational studies. Randomized trials have demonstrated continuous positive airway pressure (CPAP) therapy reduces blood pressure, markers of oxidative stress and insulin insensitivity. Yet, it remains unclear whether treatment with CPAP reduces cardiovascular events. In the largest study of its kind, 2717 patients aged 45 to 75 years with moderate-to-severe OSA and coronary or cerebrovascular disease were randomized in open-label fashion to receive CPAP treatment or usual care alone. The primary composite end point included cardiovascular death, myocardial infarction, stroke and heart failure with secondary end-points including day-time sleepiness, mood and quality of life indices. At a mean follow-up of 3.7 years, the trial was neutral with no difference in the primary end-point between the CPAP (17.0%) and the usual-care groups (15.4%) (p=0.34), and no difference in the individual components of the primary end-point. CPAP however significantly improved snoring, daytime sleepiness, mood and health-related quality of life.

Conclusions

This large trial demonstrates no benefit in CPAP over usual care in reducing the burden of cardiovascular events or death in patients with OSA and cardiovascular disease. CPAP continues to improve patient’s symptoms and quality of life indices and in this regard remains a valuable therapy.

Summarized by Hussain Contractor, James M McCabe

McEvoy RD, Antic NA, Heeley E, et al; SAVE Investigators and Coordinators. CPAP for Prevention of Cardiovascular Events in Obstructive Sleep Apnea. N Engl J Med 2016;375:919-31.

Contemporary Coronary Stents

Percutaneous treatment for obstructive coronary artery disease has evolved in conjunction with technological advances from the initial era of balloon angioplasty to the first bare metal stents (BMS) and then through various iterations of drug eluting stent (DES) technology. Current generation DES data suggest progressively improved re-stenosis and thrombosis rates and on-going trials are examining shorter duration dual antiplatelet therapy regimens, all of which raises questions about the utility of BMS. However, BMS technology has also improved and these stents generally remain less costly. Thus, in this large scale multi-center Norwegian study, over 9000 patients were randomized to receive latest generation BMS or DES technology when undergoing PCI. The primary composite outcome was all cause death and myocardial infarction over 5 years of follow-up. The primary outcome was neutral between the two groups with rates of 17.1% (BMS) vs 16.6% (DES) (p=0.66), but rates of further revascularization were significantly lower in the DES group (16.5% vs 19.8%; p<0.001) suggesting lower rates of restenosis. Definite stent thrombosis was also marginally lower in the DES group (0.8% vs 1.2%; p=0.0498) allaying concerns of very late stent thrombosis associated with early generation DES.

Conclusions

This large trial demonstrates no difference in rates of death or MI in patients receiving contemporary BMS or DES. Ongoing reductions in future revascularization episodes in patients receiving DES suggest their superiority in reducing restenosis. Incremental cost differences and potentially shorter dual antiplatelet therapy will need to be weighed against an absolute 3% difference in revascularization events at 5 years when determining optimal stent choice.

Summarized by Hussain Contractor, James M McCabe

Bønaa KH, Mannsverk J, Wiseth R, et al; NORSTENT Investigators. Drug-Eluting or Bare-Metal Stents for Coronary Artery Disease. N Engl J Med 2016;375:1242-52. [Epub ahead of print]

View Abstract

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.