Hilleman Daniel E, Mohiuddin Syed M, Packard Kathleen A
Creighton University Cardiac Center, 3006 Webster Street, Omaha, NE 68131, USA.
Chest. 2004 Feb;125(2):435-8. doi: 10.1378/chest.125.2.435.
Patients who continue to smoke following coronary artery bypass graft surgery (CABG) have substantially poorer outcomes than patients able to stop smoking after CABG. This study evaluated the effectiveness of two smoking cessation treatment strategies in patients undergoing CABG.
Two smoking cessation treatment strategies were compared in smokers who underwent CABG. In the conservative treatment strategy, smokers undergoing CABG were followed up prospectively at monthly intervals. Patients who started smoking again at any time in the year following CABG were asked to enroll in an 8-week smoking cessation program. In the aggressive treatment strategy, smokers undergoing CABG were asked to enroll in an 8-week smoking cessation program starting immediately after hospital discharge. The structure and makeup of the smoking cessation program used in the conservative and aggressive treatment strategies were identical. The primary study outcome was smoking status assessed by self-report and confirmed by expired carbon monoxide at 1.5 months, 3 months, 6 months, and 12 months after surgery.
Nineteen patients were enrolled in the conservative treatment strategy, with 2 patients unavailable for follow-up prior to the first follow-up visit. Of the remaining 17 patients, 14 patients (82%) resumed smoking at an average of 10.3 weeks after CABG. Eleven of these 14 patients (79%) agreed to participate in the smoking cessation program. Based on evaluable patients, 10 of the 17 patients (59%) in the conservative strategy group were not smoking at the 12-month follow-up. Twenty patients were enrolled in the aggressive treatment strategy. All patients agreed to participate in the smoking cessation program. All patients were available for follow-up. At the 12-month follow-up, 17 of 29 patients (85%) in this treatment strategy were not smoking. Point prevalence and continuous abstinence cessation rates were significantly greater in the aggressive treatment strategy compared to the conservative treatment strategy at all follow-up intervals after CABG.
Based on our findings in a small number of patients, an aggressive smoking cessation intervention is associated with a superior smoking cessation rate compared to a conservative treatment strategy in smokers undergoing CABG. A larger study will be needed to confirm that an early aggressive smoking cessation intervention should be provided to all smokers undergoing CABG.
冠状动脉搭桥手术（CABG）后继续吸烟的患者比CABG后能够戒烟的患者预后要差得多。本研究评估了两种戒烟治疗策略对接受CABG患者的有效性。
对接受CABG的吸烟者比较两种戒烟治疗策略。在保守治疗策略中，对接受CABG的吸烟者进行每月一次的前瞻性随访。CABG后一年内任何时间再次开始吸烟的患者被要求参加一个为期8周的戒烟项目。在积极治疗策略中，接受CABG的吸烟者在出院后立即被要求参加一个为期8周的戒烟项目。保守和积极治疗策略中使用的戒烟项目的结构和组成相同。主要研究结局是通过自我报告评估并在术后1.5个月、3个月、6个月和12个月通过呼出一氧化碳确认的吸烟状态。
19名患者采用保守治疗策略，2名患者在首次随访前无法进行随访。其余17名患者中，14名患者（82%）在CABG后平均10.3周恢复吸烟。这14名患者中有11名（79%）同意参加戒烟项目。基于可评估患者，保守策略组17名患者中有10名（59%）在12个月随访时不吸烟。20名患者采用积极治疗策略。所有患者都同意参加戒烟项目。所有患者都可进行随访。在12个月随访时，该治疗策略的29名患者中有17名（85%）不吸烟。在CABG后的所有随访间隔中，积极治疗策略的时点患病率和持续戒烟率均显著高于保守治疗策略。
基于我们在少数患者中的研究结果，与保守治疗策略相比，积极的戒烟干预在接受CABG的吸烟者中具有更高的戒烟率。需要进行更大规模的研究来证实应向所有接受CABG的吸烟者提供早期积极的戒烟干预。
