Effects And Mechanisms Of Sleep Quality On Slow Flow In Patients With NSTEMI During PCI

Background:Acute myocardial infarction(AMI)is a severe type of coronary heart disease(CHD).According to the data of China Cardiovascular Disease Report in 2019,the incidence of AMI is still increasing,and the overall mortality rate is on the rise.Percutaneous coronary intervention(PCI)is an important treatment,which can significantly improve the prognosis of AMI patients.However,slow blood flow or no reflow phenomenon(CSFP)often occurred during PCI,and the total incidence of CSFP was reported to be 3-6%,which was more common in emergency PCI,up to30%.CSFP not only immediately leads to adverse cardiovascular events such as intraoperative hypotension,arrhythmia,and death,but also affects the long-term prognosis of patients.At present,the mechanism of CSFP during PCI has not been fully elucidated,among which the myocardial microcirculation endothelial dysfunction,inflammatory reaction,microvasospasm and secondary microcirculation thrombosis or embolism are the most important reasons.CSFP during PCI was more common in acute coronary syndrome(ACS)in emergency PCI.ACS includes unstable angina(UA),acute ST-segment elevation myocardial infarction(STEMI)and non-ST-segment elevation myocardial infarction(NSTEMI).UA can develop into NSTEMI,and NSTEMI can also develop into STEMI.NSTEMI is one of the special states.Since the occurrence of CSFP during PCI leads to an increase of Major Adverse Cardiovascular Events(MACE)and there is currently no exact and effective treatment,the management principle of CSFP is that prevention is more important than treatment.It is the key to reduce the occurrence of CSFP to seek the target of early prevention and carry out effective intervention before surgery.Previous studies on CSFP were mostly conducted in patients with STEMI,while few focused on people with NSTEMI.Whether the study on CSFP during PCI in NSTEMI patients can bring some new thinking points for the prevention and treatment of CSFP is worth further discussion.With the in-depth research on the influence of sleep quality on the occurrence and development of cardiovascular diseases,a considerable number of studies have shown that sleep disorders have a high proportion in CHD patients,especially in patients before PCI,and are associated with the occurrence and poor prognosis of MACE in patients with CHD during perioperative period.In addition,related studies have reported that compared with normal sleep patients,patients with sleep disorders have a higher proportion of Active inflammatory response,glucose metabolism disorders,vascular endothelial dysfunction,and coronary vasospasm.Whether these are the reasons for the increased occurrence of CSFP during PCI due to sleep disorders is still controversial.However,there have been few previous reports on the correlation between sleep disturbance and CSFP occurrence in patients with coronary heart disease during PCI,with relatively small sample size and angina pectoris as the majority of participants.There is a lack of research on myocardial infarction patients receiving elective PCI and a lack of in-depth study on the corresponding mechanism.Therefore,is sleep disturbance associated with increased CSFP during elective NSTEMI PCI? Is the mechanism of sleep disturbance promoting increased CSFP in patients with NSTEMI during PCI related to its effect on inflammatory response and vascular endothelial function? Further studies and confirmations are needed to explore new prevention strategies and intervention targets for reducing intraoperative CSFP in PCI patients with CHD.Objectives:To study the relationship between sleep quality of NSTEMI patients receiving elective PCI treatment and the occurrence of intraoperative CSFP in PCI,and to further explore the influence of sleep disturbance on intraoperative CSFP in NSTEMI patients with PCI and the corresponding mechanism,so as to explore new prevention strategies and intervention targets for reducing intraoperative CSFP in CHD patients with PCI.Methods:A total of 308 patients admitted to the Department of Cardiovascular Medicine of Guangzhou First People’s Hospital for diagnosis of NSTEMI and receiving elective PCI from March 2019 to March 2021 were included.General medical history and relevant examination data were collected.The Pittsburg Sleep Quality Index(PSQI)was calculated and the endothelial-dependent flow-mediated vasodilation of the brachial artery(FMD)was detected by ultrasonography in all patients one day before PCI.On the morning of elective PCI,venous blood was extracted on an empty stomach and inflammatory mediators(including IL-2,INF-γ,TNF-α,IL-4,IL-6 and IL-10)in venous blood were detected.The thrombolysis in myocardial infarction(TIMI)during PCI were divided into two groups: the CSFP group(81 cases)and the non-CSFP group(227 cases).The differences of PSQI score,FMD and inflammatory cytokines between 2 groups were compared.In addition,according to whether the total score of PSQI was > 7,patients in the CSFP group(n=81)were divided into the sleep disorder group(64 cases)(PSQI > 7)and the normal sleep group(17 cases)(PSQI≤7),and the differences in related indexes between the two groups were compared.SPSS25.0 statistical software was used to analyze all indicators.Results:(1)There were statistically significant differences in diabetes,D-Dimer,albumin,Hcy,hs-CRP,PSQI total score,actual sleep time,sleep efficiency,PSQI total score >7,TNF-α,IL-6,IL-10 and FMD between CSFP group and non-CSFP group(P< 0.05).(2)The sleep quality of NSTEMI patients in the CSFP group was significantly lower than that in the non-CSFP group(11.72±3.91 vs.7.26±1.97,P < 0.01),and the proportion of sleep disorders in the CSFP group was significantly higher than that in the non-CSFP group(79.01% vs.56.83%,P < 0.01).(3)Spearman correlation analysis showed that the average CTFC of NSTEMI patients in the two groups was positively correlated with the total score of PSQI(r=0.74,P < 0.01).(4)Multi variate Logistic regression analysis showed that diabetes mellitus(OR=1.69,95%CI: 1.43～5.28,P < 0.01),PSQI total score(OR=1.79,95%CI:1.56～5.38,P < 0.01),PQI total score > 7(OR=2.47,95%CI: 1.98～7.19,P < 0.01),FMD(OR=-4.32,95%CI: 0.31～0.74,P < 0.01)was an independent risk factor for CSFP during PCI in NSTEMI patients.(5)In 81 patients with CSFP during PCI,the inflammatory mediators IL-2 and TNF-α in the sleep disturbance group were significantly higher than those in the normal sleep group(41.19±7.02 vs 35.82±8.34,26.75±8.76 vs 22.24±6.72,P < 0.05).IL-6 and IL-10 were significantly lower than those in normal sleep group(17.45±8.14 vs.26.04±10.02,51.31±18.24 vs.59.86±17.09,P < 0.05).FMD in the sleep disorder group was significantly lower than that in the normal sleep group(4.11±1.61 vs14.29±2.18,P < 0.01).Conclusion:(1)Sleep disturbance before elective PCI led to increased slow blood flow in patients with NSTEMI during PCI.(2)Sleep disturbance may aggravate inflammatory response and impair vascular endothelial function,which may be the mechanism to promote the increase of CSFP in NSTEMI patients during elective PCI.