Weiner P, Waizman J, Weiner M, Rabner M, Magadle R, Zamir D
Department of Medicine A, Hillel Yaffe Medical Center, Hadera, Israel.
Isr Med Assoc J. 2000 Jun;2(6):446-9.
Cigarette smoking is a major contributor to the risk of acute myocardial infarction and the subsequent morbidity and mortality. Physicians can play an important role in smoking cessation among patients with AMI because of their frequent contact with the patient during the event.
To study the prevalence of smoking, age, localization of coronary occlusion, mortality and rate of smoking cessation in consecutive patients who were diagnosed with a first AMI in our center in 1989-93.
The study included 1,510 consecutive patients with first AMI: 973 men (512 smokers, 52.6%) and 537 women (215 smokers, 40%), whose mean age was 64.1 +/- 6.7 and 68.6 +/- 5.2 years respectively.
The median age at the first AMI in non-smoking and smoking men differed significantly (70.4 +/- 6.8 vs. 56.6 +/- 6.1 years, P < 0.001) while the difference in the women was smaller (70.4 +/- 6.9 vs. 66.8 +/- 7.2). The proportion of smokers/non-smokers among men was greater at a younger age and decreased proportionally with age. The overall mortality was 11.3% with a significant difference in mortality rate in the younger age groups between smokers and non-smokers (1% vs. 0% in the age group 31-40 years, P < 0.05, and 6.1% vs. 0.8% in the 41-50 year age group, P < 0.001). Only 62% of the smokers who survived the AMI declared that they had received anti-smoking advice from a physician during hospitalization. The cessation rate in this group was significantly higher than in smokers who had not been cautioned against smoking (56% vs. 18%).
Current smokers sustained their first AMI more than one decade earlier than non-smokers, and the younger smokers had a higher mortality rate. The majority of the smokers who received anti-smoking advice during their hospitalization for AMI quit smoking in the year following the acute event.
吸烟是急性心肌梗死风险以及后续发病率和死亡率的主要促成因素。由于医生在急性心肌梗死事件期间与患者频繁接触，他们在急性心肌梗死患者戒烟方面可发挥重要作用。
研究1989 - 1993年在我们中心确诊首次急性心肌梗死的连续患者中的吸烟率、年龄、冠状动脉闭塞部位、死亡率及戒烟率。
该研究纳入1510例首次急性心肌梗死的连续患者：973例男性（512例吸烟者，占52.6%）和537例女性（215例吸烟者，占40%），其平均年龄分别为64.1±6.7岁和68.6±5.2岁。
非吸烟男性和吸烟男性首次急性心肌梗死时的中位年龄差异显著（70.4±6.8岁对56.6±6.1岁，P<0.001），而女性的差异较小（70.4±6.9岁对66.8±7.2岁）。男性中吸烟者/非吸烟者的比例在较年轻年龄段更大，且随年龄成比例下降。总体死亡率为11.3%，吸烟者和非吸烟者在较年轻年龄组的死亡率存在显著差异（31 - 40岁年龄组中分别为1%对0%，P<0.05；41 - 50岁年龄组中分别为6.1%对0.8%，P<0.001）。急性心肌梗死存活的吸烟者中只有62%宣称他们在住院期间接受了医生的戒烟建议。该组的戒烟率显著高于未被告诫吸烟的吸烟者（56%对18%）。
当前吸烟者首次发生急性心肌梗死的时间比非吸烟者早十多年，且较年轻的吸烟者死亡率更高。大多数在急性心肌梗死住院期间接受戒烟建议的吸烟者在急性事件后的一年内戒烟。
