接受直接冠状动脉介入治疗的急性心肌梗死患者中的“吸烟者悖论”

["Smoker's paradox" in patients with acute myocardial infarction receiving primary coronary intervention].

作者信息

Katayama Toshiro, Iwasaki Yoshihiro, Yamamoto Tadashi, Yoshioka Masato, Nakashima Hiroshi, Suzuki Shin, Honda Yukiharu, Yano Katsusuke

机构信息

Department of Cardiology, Kouseikai Hospital, Nagasaki.

出版信息

J Cardiol. 2006 Oct;48(4):193-200.

PMID:17066622

Abstract

OBJECTIVES

Smokers with acute myocardial infarction have lower mortality rates than non-smokers despite increased risk for coronary artery disease. This study assessed the effects of smoking on complications and outcomes after acute myocardial infarction, and investigated the relationship between the clinical factors and the paradoxical effects of smoking in patients receiving primary coronary intervention.

METHODS

Subjects were 367 consecutive patients with acute myocardial infarction who were admitted within 24 hr of onset and underwent successful coronary intervention, 165 (45%) of whom were smokers.

RESULTS

The smoking group contained significantly more male patients, and the smoking group was significantly younger than the non-smoking group (p < 0.0001). The value of acute phase brain natriuretic peptide (BNP) and atrial natriuretic peptide (ANP) were significantly lower (BNP: 250 +/- 366 vs 448 +/- 513pg/ml, p = 0.0002; ANP: 48 +/- 77 vs 74 +/- 82pg/ml, p = 0.005) in the smoking group. Peak creatine kinase time from onset was significantly earlier (12.9 +/- 9.3 vs 16.1 +/- 10.0 hr, p = 0.049) in the smoking group. Left ventricular ejection fraction in the chronic phase was significantly better in the smoking group (58 +/- 13% vs 52 +/- 14%, p = 0.03). The early ST-segment resolution rate was higher in the smoking group (81% vs 67%, p = 0.003), and there were significantly fewer patients with heart failure in the smoking group than in the non-smoking group (28% vs 41%, p = 0.01). The cardiac mortality rate during 6 months was significantly lower in the smoking group (3% vs 9%, p = 0.01). The beneficial effects of smoking on the prognosis were related with the differences in sex and age of the study group.

CONCLUSIONS

The reason why smokers with acute myocardial infarction have lower mortality rates than non-smokers, the "smoker's paradox", may be related to less damage to the microvascular function after primary coronary intervention, with lower BNP and better left ventricular ejection fraction.

摘要

目的

尽管急性心肌梗死患者患冠状动脉疾病的风险增加，但吸烟者的死亡率低于不吸烟者。本研究评估了吸烟对急性心肌梗死后并发症和预后的影响，并调查了接受直接冠状动脉介入治疗患者的临床因素与吸烟的矛盾效应之间的关系。

方法

研究对象为367例连续的急性心肌梗死患者，这些患者在发病后24小时内入院并成功接受了冠状动脉介入治疗，其中165例（45%）为吸烟者。

结果

吸烟组男性患者明显更多，且吸烟组比不吸烟组明显更年轻（p<0.0001）。吸烟组急性期脑钠肽（BNP）和心钠肽（ANP）的值明显更低（BNP：250±366 vs 448±513pg/ml，p = 0.0002；ANP：48±77 vs 74±82pg/ml，p = 0.005）。吸烟组从发病到肌酸激酶峰值时间明显更早（12.9±9.3 vs 16.1±10.0小时，p = 0.049）。吸烟组慢性期左心室射血分数明显更好（58±13% vs 52±14%，p = 0.03）。吸烟组早期ST段回落率更高（81% vs 67%，p = 0.003），且吸烟组心力衰竭患者明显少于不吸烟组（28% vs 41%，p = 0.01）。吸烟组6个月内心脏死亡率明显更低（3% vs 9%，p = 0.01）。吸烟对预后的有益影响与研究组的性别和年龄差异有关。