van Domburg R T, Meeter K, van Berkel D F, Veldkamp R F, van Herwerden L A, Bogers A J
Thoraxcenter, University Hospital Rotterdam Dijkzigt, Rotterdam, The Netherlands.
J Am Coll Cardiol. 2000 Sep;36(3):878-83. doi: 10.1016/s0735-1097(00)00810-x.
The goal of this study was to determine the influence of smoking cessation on mortality after coronary artery bypass graft surgery (CABG), which has still not been established clearly.
Cigarette smoking is one of the known major risk factors of coronary artery disease.
One thousand and forty-one patients underwent CABG between 1971 and 1980. The preoperative and postoperative smoking habits of 985 patients (95%) could be retrieved and were analyzed in a multivariate Cox analysis.
The median follow-up was 20 years (range 13 to 26 years). Smoking status before surgery did not entail an increased risk of mortality: patients who had smoked before surgery and those who had not smoked in the year before surgery had a similar probability of survival. However, smoking cessation after surgery was an important independent predictor of a lower risk of death and coronary reintervention during the 20-year follow-up when compared with patients who continued smoking. In analyses adjusted for baseline characteristics, the persistent smokers had a greater relative risk (RR) of death from all causes (RR 1.68 [95% confidence interval 1.33 to 2.13]) and cardiac death (RR 1.75 [1.30 to 2.37]) as compared with patients who stopped smoking for at least one year after surgery. The estimated benefit of survival for the quitters increased from 3% at five years to 14% at 15 years. The quitters were less likely to undergo repeat CABG or a percutaneous coronary angioplasty procedure (RR 1.41 [1.02 to 1.94]).
Patients who continued to smoke after CABG had a greater risk of death than patients who stopped smoking. They also underwent repeat revascularization procedures more frequently. Cessation of smoking is therefore strongly recommended after CABG. Clinicians are encouraged to start or to continue smoking-cessation programs in order to help smokers to quit smoking, especially after CABG.
本研究旨在确定冠状动脉搭桥术（CABG）后戒烟对死亡率的影响，目前这一影响尚未明确。
吸烟是已知的冠状动脉疾病主要危险因素之一。
1971年至1980年间，1041例患者接受了冠状动脉搭桥术。985例患者（95%）术前和术后的吸烟习惯可追溯，并在多因素Cox分析中进行了分析。
中位随访时间为20年（范围13至26年）。术前吸烟状态并未增加死亡风险：术前吸烟的患者与术前一年未吸烟的患者有相似的生存概率。然而，与继续吸烟的患者相比，术后戒烟是20年随访期间死亡风险和冠状动脉再次干预风险降低的重要独立预测因素。在根据基线特征进行调整的分析中，与术后至少戒烟一年的患者相比，持续吸烟者全因死亡的相对风险（RR）更高（RR 1.68 [95%置信区间1.33至2.13]），心脏性死亡的相对风险更高（RR 1.75 [1.30至2.37]）。戒烟者的生存获益估计从5年时的3%增加到15年时的14%。戒烟者接受再次冠状动脉搭桥术或经皮冠状动脉介入治疗的可能性较小（RR 1.41 [1.02至1.94]）。
冠状动脉搭桥术后继续吸烟的患者比戒烟的患者死亡风险更高。他们也更频繁地接受再次血运重建手术。因此，强烈建议冠状动脉搭桥术后戒烟。鼓励临床医生启动或继续戒烟项目，以帮助吸烟者戒烟，尤其是在冠状动脉搭桥术后。
