Obstructive sleep apnea syndrome in chronic total occlusion percutaneous coronary intervention; insights from the PROGRESS-CTO registry

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OBJECTIVE: To examine the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in patients with obstructive sleep apnea syndrome (OSAS). METHODS: We compared the procedural characteristics and outcomes of CTO PCIs in patients with and without OSAS in a multicenter registry. RESULTS: Of 7403 patients who underwent 7408 CTO PCIs between 2012 and 2024 at 47 centers, 942 (13%) had OSAS. Compared with patients without OSAS, patients with OSAS were older; more likely to be men; and had higher prevalence of diabetes, hypertension, dyslipidemia, cerebrovascular disease, previous heart failure, coronary artery bypass graft surgery, and prior PCI. They had higher J-CTO (2.73 ± 1.20 vs. 2.30 ± 1.25; p < 0.001) and PROGRESS-CTO (1.35 ± 1.01 vs. 1.16 ± 0.96; p < 0.001) scores, longer lesion length, and more complex angiographic characteristics. Compared with patients without OSAS, OSAS patients had similar technical success (87.6% vs. 88.3%, p = 0.552) and procedural success (85.9% vs. 87.2%, p = 0.260). There were no differences in terms of in hospital MACEs and death. After a median follow-up of 71 days, the incidence of MACEs (3.9% vs. 1.6%, p = 0.026) and death (2.6% vs. 0.6%, p = 0.003) was higher in patients with OSAS. In multivariable analysis, OSAS was independently associated with higher follow-up MACEs (hazard ratio 2.32, 95% confidence intervals 1.22-3.26, p = 0.006). CONCLUSION: OSAS is common in patients undergoing CTO PCI. Compared with patients without OSAS, OSAS patients had more comorbidities and more complex CTOs, similar rates of periprocedural success and complications, and higher incidence of follow-up MACEs.

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