Hasdai D, Lerman A, Rihal C S, Criger D A, Garratt K N, Betriu A, White H D, Topol E J, Granger C B, Ellis S G, Califf R M, Holmes D R
Mayo Clinic and Foundation, Rochester, MN, USA.
Am Heart J. 1999 Apr;137(4 Pt 1):612-20. doi: 10.1016/s0002-8703(99)70213-9.
Because of the increased propensity of intracoronary thrombi to form in cigarette smokers, percutaneous transluminal angioplasty (PTCA) for acute myocardial infarction (AMI) may be less effective in smokers. We sought to determine the impact of smoking status on outcome after PTCA for AMI.
Patients enrolled in the GUSTO IIb Angioplasty Substudy were randomly assigned to receive PTCA or tissue-plasminogen activator (tPA) for AMI. The interaction of smoking status (nonsmokers = 344, former smokers = 294, current smokers = 490) and treatment strategy with the occurrence of death, nonfatal reinfarction, or nonfatal, disabling stroke at 30 days was analyzed. Procedural success (residual stenosis <50% and Thrombolysis in Myocardial Infarction [TIMI] flow grade 3) was also analyzed for patients who underwent PTCA (n = 444).
Among patients who underwent PTCA, nonsmokers had worse percent stenosis of the culprit lesion before reperfusion (P =.03) and more often had TIMI flow grade 0 (P <.05). Procedural success was more common in smokers (65.6%) than in former smokers (53.3%) and nonsmokers (52. 4%; P =.02), reflecting a higher rate of postprocedure TIMI 3 flow. PTCA was associated with a better 30-day outcome than tPA for current smokers (odds ratio [95% confidence interval] = 0.41 [0.19 to 0.88]), with a similar trend for former smokers (0.73 [0.34 to 1. 58]) and nonsmokers (0.77 [0.42 to 1.40]). At 6 months, smokers randomly assigned to PTCA also had fewer deaths and reinfarction (0. 58 [0.31 to 1.07]).
Although smoking status affects angiographic variables before and after PTCA for AMI, PTCA is associated with a better 30-day outcome than tPA regardless of smoking status and should be considered when readily available.
由于吸烟者冠状动脉内血栓形成的倾向增加，经皮腔内血管成形术（PTCA）治疗急性心肌梗死（AMI）对吸烟者可能效果较差。我们试图确定吸烟状态对AMI患者PTCA术后结局的影响。
入选GUSTO IIb血管成形术亚研究的患者被随机分配接受PTCA或组织型纤溶酶原激活剂（tPA）治疗AMI。分析吸烟状态（非吸烟者=344例，既往吸烟者=294例，当前吸烟者=490例）和治疗策略与30天时死亡、非致命性再梗死或非致命性致残性卒中发生情况的相互作用。对接受PTCA的患者（n=444）也分析了手术成功率（残余狭窄<50%且心肌梗死溶栓[TIMI]血流分级为3级）。
在接受PTCA的患者中，非吸烟者再灌注前罪犯病变的狭窄百分比更差（P=0.03），且更常出现TIMI血流0级（P<0.05）。手术成功率在吸烟者（65.6%）中比既往吸烟者（53.3%）和非吸烟者（52.4%）更常见（P=0.02），这反映了术后TIMI 3级血流的发生率更高。对于当前吸烟者，PTCA与30天结局优于tPA相关（优势比[95%置信区间]=0.41[0.19至0.88]），既往吸烟者（0.73[0.34至1.58]）和非吸烟者（0.77[0.42至1.40]）有类似趋势。在6个月时，随机分配接受PTCA的吸烟者死亡和再梗死也较少（0.58[0.31至1.07]）。
尽管吸烟状态影响AMI患者PTCA术前和术后的血管造影变量，但无论吸烟状态如何，PTCA与30天结局优于tPA相关，并且在可随时进行时应予以考虑。
