Professor Roffi acknowledged that balancing risk
with benefit is “not easy.” He stressed, “If you
have a patient with acute myocardial infarction
undergoing stenting, then reassess the patient at
12 months. At this time, use the criteria of the
PEGASUS study, which determined risk based on
the presence of diabetes, multivessel disease, renal
insufficiency, maybe the patient has already had
multiple events; if they have such risk factors, then
maybe consider prolonged (DAPT) if they remained
free of bleeding events.”
Doesn’t That Just Blow?
The SERVE-HF (Treatment of Sleep-Disordered
Breathing with Predominant Central Sleep Apnea
by Adaptive Servo Ventilation in Patients with
Heart Failure) study showed that this particular
ventilatory support therapy effectively treats central sleep apnea, which is found in 25% to 40% of
patients with heart failure. Unfortunately—well,
here is Martin R. Cowie, MD, the study’s first
author: “There was no difference in outcome and,
surprisingly—which has taken cardiologists and
respiratory physicians completely by surprise—we
found an increase in mortality. And, if you look
at cardiovascular mortality, it was up 34% (TABLE
1). So, not only does it not make any difference to
patients with systolic HF, it actually increases the
risk of them dying. This is a real game-changer
trial, really important.”
Of course, obstructive sleep apnea responds
well to positive airway pressure (PAP), but for
central sleep apnea, which is a neurological problem that can spring from many different causes, a
different kind of device was thought to be necessary. The adaptive servo-ventilation machine uses
an algorithm that detects significant reductions
or pauses in bre